To propose a five-dimensional, phenotype-oriented multimodality imaging framework for cardiovascular care that integrates various aspects of cardiac function beyond left ventricular ejection fraction (LVEF).
Approach:
Framework Development: The review synthesizes multimodality imaging evidence into a five-dimensional framework encompassing pump function, myocardial deformation, diastolic function, flow dynamics, and tissue characterization.
Stepwise Escalation Strategy: A selective stepwise escalation strategy is proposed, starting with standard echocardiography and advancing to other imaging modalities as clinically indicated.
Key Findings:
LVEF alone is insufficient for capturing the complexity of cardiac physiology and may miss early myocardial dysfunction.
Multidimensional functional phenotyping can refine disease characterization and risk stratification in various cardiac conditions.
The integration of biomarkers across five domains may provide a more comprehensive understanding of cardiac dysfunction.
Interpretation:
The proposed framework aims to enhance the interpretability and clinical utility of multimodality imaging in cardiovascular management by organizing assessments around functional phenotypes.
Limitations:
Practical barriers to implementation include cost-effectiveness, workflow burden, vendor variability, and limited standardization of advanced imaging techniques.
The need for interpretable and externally validated AI-based integration is highlighted.
Conclusion:
The review emphasizes the importance of a structured approach to cardiac functional assessment that prioritizes clinically actionable interpretations over indiscriminate use of imaging modalities.
