AUTHOR=Lau Clement , Elshibly Mohamed M. M. , Kanagala Prathap , Khoo Jeffrey P. , Arnold Jayanth Ranjit , Hothi Sandeep Singh 

TITLE=The role of cardiac magnetic resonance imaging in the assessment of heart failure with preserved ejection fraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.922398

DOI=10.3389/fcvm.2022.922398

ISSN=2297-055X

ABSTRACT=Heart failure (HF) is a major cause of morbidity and mortality worldwide. Current classifications of HF categorise patients with a left ventricular ejection fraction of 50% or greater as HF with preserved ejection fraction or diastolic HF.  Echocardiography is the first line imaging modality in assessing diastolic function given its practicality, low cost and the utilisation of Doppler imaging.  However, the last decade has seen cardiac magnetic resonance (CMR) emerge as a valuable test for the sometimes challenging diagnosis of diastolic HF.  The unique ability of CMR for myocardial tissue characterisation coupled with high resolution imaging provides additional information to echocardiography that may help in phenotyping diastolic HF and provide prognostication for patients with HF.  The precision and accuracy of CMR underlies its use in clinical trials for the assessment of novel and repurposed drugs in diastolic HF.  Importantly, CMR has powerful diagnostic utility in differentiating acquired and inherited heart muscle diseases presenting as diastolic HF such as Fabry disease and amyloidosis with specific treatment options to reverse or halt disease progression. 
This state of the art review will outline established CMR techniques such as transmitral velocities and strain imaging of the left ventricle and left atrium in assessing diastolic function and their clinical application to diastolic HF.  Furthermore, it will include a discussion on novel methods and future developments such as stress CMR and MR spectroscopy to assess myocardial energetics, which show promise in unravelling the mechanisms behind diastolic HF that may provide targets for much needed therapeutic interventions.