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cardiac sarcoidosis (see Supplementary data online, Table S2).181,182 Genetic testing may be appropriate when a genetic cause is suspected and the results may provide management and prognostic guidance, result in cascade family screening or reproductive management. For more specific guidance on genetic testing in specific cardiomyopathies, we refer to the 2023 ESC Guidelines for the management of cardiomyopathies.48,124
5.3.1 Cardiac imaging in heart failure: a multimodality
approach Multimodal cardiac imaging plays a pivotal role in the diagnosis, management, and prognostic assessment of HF, enabling precise subtyping to aid in disease-specific therapy selection and is supported by a growing body of evidence (Figure 7). Echocardiography is considered the first-line imaging modality in HF and remains the cornerstone of assessment. Echocardiography has widespread availability, is noninvasive, and provides the ability for real-time dynamic evaluation of cardiac structures, dimensions, volumes, filling patterns, haemodynamics, and function. Tissue Doppler imaging and speckle-tracking echocardiography have allowed clinicians to quantify myocardial global longitudinal strain, offering more sensitive measures of early systolic dysfunction even before LVEF declines, which is of particular value in patients undergoing chemotherapy, or specific strain patterns that may be suggestive of amyloidosis or HCM.183–185 In patients with HFpEF, diastolic stress testing is emerging as an important tool to unmask diastolic dysfunction that may not be apparent at rest. Depending on echocardiography findings, additional imaging modalities or
Figure 7 Multiparametric approach to aetiology assessment in heart failure. 18F-FDG-PET, 18F-fluorodeoxyglucose-positron emission tomography; CMR, cardiac magnetic resonance; CTCA, computed tomography coronary angiography; DPD, 3,3-diphosphono- 1,2-propanodicarboxylic acid; ECG, electrocardiogram; EMB, endomyocardial biopsy; HMPD, hydroxymethylene diphosphonate; ICA, invasive coronary angiography; PYP, pyrophosphate; RHC, right heart catheterization. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026
