Metabolic imaging Magnetic resonance imaging and positron emission tomography as predictors of heart failure

Heart failure is a clinical syndrome of ischemic and non ischemic etiology. Imaging plays a major part in diagnosing its cause, course, and prognosis. In the ischemic heart, positron emission tomography (PET), by, for example, assessing myocardial perfusion and glucose metabolism, and magnetic resonance imaging (MRI), by evaluating myocardial function, myocardial necrosis, and/or inotropic contractile reserve, can predict contractile recovery, and therefore potential improvement of heart failure, after revascularization. In non ischemic cardiomyopathies such as dilative or hypertrophic cardiomyopathy, PET serves as an important tool for the assessment of metabolic changes, whereas MRI serves as the gold standard for measuring cardiac volumes and mass. In addition, late gadolinium enhancement MRI, which assesses regional fibrotic alteration of the myocardium, serves as a potential marker of disease progression and patient prognosis. Heart Metab. 2009;42:15–20.