Multimodality Imaging in Advanced Heart Failure. A Clinical Consensus Statement of the Heart Failure Association of the ESC. Part 2: Mechanical Circulatory Support and Heart Transplantation

For temporary and durable mechanical circulatory support (MCS), multimodality imaging, primarily echocardiography, is crucial for candidate selection, proper device placement and post-implantation monitoring.

Preoperatively, imaging identifies heart failure (HF) phenotypes, assesses ventricular function, detects intracardiac thrombi and evaluates valves; key measurements: ventricular size, EF and cardiac output.

Intraoperative imaging ensures optimal device placement and complication detection.

Post-implantation echocardiography assesses heart–MCS interplay, early complications, ventricular unloading and RV function; serial imaging is essential for patient and device management and complications.

In temporary MCS, imaging is vital in the weaning process.

After heart transplantation (HT), imaging is crucial from early postoperative monitoring to long-term follow-up; echocardiography is first-line.

CMR provides detailed evaluation of cardiac structure and function, including fibrosis, oedema and myocardial perfusion.

Coronary CT angiography and PET are possible alternatives for assessing coronary allograft vasculopathy.