Heart failure (HF) is a multifaceted syndrome addressing for an high rate of death among general population. The common approach to this disease has been always based on the evaluation of the left ventricular ejection fraction by two-dimensional echocardiography with Simpson¿s method. Mounting evidences have demonstrated the pitfalls of this method and have suggested that the management of heart failure requires a deep knowledge of the pathophysiological insights of the disease and cannot rely only on the evaluation of the left ventricular ejection fraction. Several advanced imaging technologies overwhelm the evaluation of ejection fraction and could provide a better understanding of the myocardial abnormalities underlying heart failure. Morover, cardiovascular imaging alone defines disease. We rarely look at tissue. Almost all heart failure patients fail, wasting billions. Where successful, benefit is modest - we control, not cure disease. We should change this. The present research project plan to use scanning, genetics and molecular analysis to optimally conventionally define heart failure. We aim to study activated pathways and simulate the heart at all scales of disease, enrolling 50 patients with HF due to ischemic etiology and 50 HF patients due to non-ischemic etiology (i.e. myocarditis and cardiomyopathies). By linking these to outcomes that matter (death, heart failure, arrhythmia and response to therapy), we aim to redefine heart failure based commonality, difference, define causal biology,. We aim to identify treatable pathways for personalized therapy, and re-group diseases by both process and imaging aspects, retargeting existing treatments to try to improve outcomes of millions.
During the past decades, physicians endeavoured to classify HF in order to improve the understanding of this multifaceted syndrome and best serving the needs of patients. Starting from the assumption of HF as a mechanical dysfunction of the heart, the measure of left ventricular (LV) function as the fraction of the LV end-diastolic volume ejected per beat was considered the best parameter for the detection and management of heart abnormalities. the development of two-dimensional echocardiography allowed the use of LVEF as primary measure of left ventricular function and heralded the widespread adoption of LVEF-based classification of HF.
In the complexity of heart failure syndrome, identification of pathophysiology and etiology is the only way to define a correct diagnosis. HF is not just take care of its symptoms. It is mandatory to decipher the mechanisms underlying HF that is a multiorgan syndrome. In order to reach the best stratification of the patient and to choose the most appropriate treatment, it is fundamental to comprehend the pathophysiological mechanisms and structural and functional modifications underlying HF.