Heart failure with preserved ejection fraction assessed by cardiac magnetic resonance: From clinical uses to emerging techniques

Patients with heart failure with preserved ejection fraction (HFpEF) account for approximately 50% of those with heart failure (HF) and have increased morbidity and mortality when compared to those with HF with reduced ejection fraction. Currently, the pathophysiology and diagnostic criteria for HFpEF remain unclear, contributing significantly to delays in creating a beneficial and tailored treatment that can improve the prognosis of HFpEF. A multitude of studies have exclusively tested and illustrated the diagnostic value of echocardiography imaging in HFpEF; however, a widely-accepted criterion to identify HFpEF using cardiovascular magnetic resonance (CMR) imaging has not been established. As the gold standard for cardiac structural, functional measurement, and tissue characterization, CMR holds great potential for the early discovery of the pathophysiology, diagnosis, and risk stratification of HFpEF. This review aims to comprehensively discuss the diagnostic and prognostic role of CMR parameters in the setting of HFpEF through validated routine and prospective emerging techniques, and provide clinical perspectives for CMR imaging application in HFpEF.