Imaging heart failure: European Society of Cardiology releases position statement

Takeaway

• For unstable patients with acute heart failure (AHF), bedside ultrasonography of the heart and lungs is crucial.

Why this matters

• This statement offers advice on use of imaging for HF patients according to the time frame laid out in recent European Society of Cardiology (ESC) guidelines.

Description

• Position statement issued by ESC’s Heart Failure Association.

Key details

• AHF is frequently misdiagnosed based on history and physical.
• Urgent phase: if patient with suspected AHF is unstable, use bedside focused cardiac ultrasound (FoCUS) and lung ultrasound.
  • Portable ultrasound represents “an extension of the physical examination of the chest.”
  • This tool can differentiate between obstructive, cardiogenic, hypovolemic, and distributive shock.
  • Use lung ultrasound to check for interstitial syndrome, pleural effusion, pneumothorax.
• At 60-120 minutes:
  • Unstable patients with acute coronary syndrome (ACS) should undergo invasive angiography.
  • Those with suspected pulmonary embolism or aortic dissection may undergo CT.
  • Triple-rule-out CT is best for patients at low to intermediate ACS risk.
  • Absence of pulmonary congestion on chest X-ray does not rule out HF.
• At stabilization phase (24-48 hours):
  • Patients should undergo comprehensive echocardiography.
  • MRI is acceptable alternative if echo image quality is poor.
• Later imaging options include cardiac MR, stress imaging, nuclear imaging, CT, invasive imaging.
• This article provides only a summary; consult full text for details.