Diagnostic Testing and the Assessment of Heart Failure

Diagnosis of heart failure is being increasingly relied upon on advanced imaging technologies and diagnostic tests. A thorough history and a competent physical examination, followed by an electrocardiogram, basic laboratory studies, and an echocardiogram, remain a sound approach to the initial evaluation of heart failure. Echocardiography is the most useful diagnostic test readily available for the assessment of cardiac structure and function where as cardiac magnetic resonance imaging is the gold standard for the measurement of chamber volume, mass, and thereby ventricular systolic function. Measurement of BNP improves diagnostic accuracy, especially in the acute setting. Evaluation for coronary artery disease is critical. Invasive hemodynamic assessment is not routinely indicated in the diagnosis of heart failure but it is essential in patients being considered for advanced heart failure therapeutic options including cardiac transplantation or left ventricular assist device.