Cardiac magnetic resonance imaging in chronic heart failure

The prevalence of heart failure (HF) continuously increases due to the aging population and success in treating cardiovascular diseases that often lead to HF. Cardiac magnetic resonance (CMR) imaging has emerged as a comprehensive tool in the diagnosis and follow-up of patients with HF. The accuracy and reproducibility in evaluating cardiac structures, the unique ability of noninvasive tissue characterization, and the lack of ionizing radiation make CMR very attractive as a potential “all-in-one technique”: it provides valuable data to confirm or establish the diagnosis, screen subclinical cases, identify etiology, assess the prognosis, setting a risk stratification [based on evaluation of proved independent prognostic factors as ejection fraction (EF), end systolic volume, myocardial fibrosis], follow-up, and monitoring the response to the therapy. In this chapter, the pivotal role of CMR in the comprehensive evaluation of patients with HF is discussed, highlighting the key features guiding differential diagnosis and the assessment of prognosis. A comparison with stress echocardiography is reported. In addition, the role of cardiac computed tomography angiography (CCTA) in patients affected by chronic HF is analyzed.