Should everyone have an MRI in heart failure?

Heart failure (HF) is a complex clinical syndrome characterized by typical symptoms and signs caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. HF patients can be classified into three categories based on left ventricular systolic function: HF with reduced ejection fraction (<40%, HFrEF), HF with mid-range ejection fraction (40–49%, HFmrEF), and HF with preserved ejection fraction (≥50%, HFpEF). Despite recent advances in disease prevention and treatment, HF remains a public health problem worldwide associated with substantial morbidity and mortality, reduced health-related quality of life, and significant burden on health care systems. HF affects around 26 million people worldwide with an estimated prevalence of 1–2% of the adult population in developed countries and a steep increase with increasing age, rising to above 10% among people >70 years of age and above 15% in people >80 years of age (1,2). Although the incidence of HF is decreasing, the overall prevalence and hospitalization rates have increased and are expected to rise substantially in the next two decades due to the ageing population, better survival of patients with ischemic heart disease and cardiomyopathies, and a growing proportion of patients presenting with HFpEF (3,4). There is a wide range of abnormalities of the myocardium, pericardium, endocardium, and heart valves, cardiac rhythm disorders or systemic diseases that can cause HF. Determining the underlying cause is central to the diagnosis and treatment planning of HF (1,5). Imaging in HF: magnetic resonance imaging pros, cons, and appropriateness criteria