Role of cardiac magnetic resonance in heart failure with preserved ejection fraction

Purpose of Review: Approximately half of the patients presenting with heart failure have preserved ejection fraction. These patients usually have a combination of underlying etiologies and may profit from individualized treatment. Failure of clinical trials without adequate understanding of the underlying problem highlights the need for an in-depth assessment of this complex clinical syndrome. This review seeks to discuss the role of cardiovascular magnetic resonance imaging (CMR) in improving diagnosis and targeted management of heart failure with preserved ejection fraction (HFpEF).Recent Findings: Technical advances in tissue mapping techniques enable a virtual histopathological perspective to detect myocardial disease processes, such as inflammation, infiltration, and fibrosis. Myocardial perfusion imaging enables separation between regional ischemia due to epicardial coronary artery disease (CAD) and microvascular disease. Finally, computation of aortic pulse wave velocity (PWV) provides insight into the effects of the vascular stiffness on the efficiency of cardiac work.Summary: A comprehensive CMR protocol enables identification of the underlying pathophysiology in patients with HFpEF, allows identification of important differential diagnoses in patients with specific diseases, and may lead to imaging-guided precision medicine in HFpEF