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Cardiac imaging in heart failure in the personalized medicine era: Pathway to knowledge or Tiresias’ paradox?

Published:January 08, 2021DOI:https://doi.org/10.1016/j.ejim.2020.12.020

      Highlights

      • Cardiac imaging may be intended as the technological extension of human eyes.
      • Currently, heart failure classifications are mainly based on echocardiography-derived assessment of left ventricular ejection fraction.
      • Cardiac imaging has witnessed exponential technological advances in the last decades.
      • A higher degree of complexity in cardiac imaging has repercussions on ability to correctly interpret significance.
      • Mere assessment through the lens of cardiac imaging may be intrinsically limited.
      • Tiresias myth is a reminder that knowledge does not equate empiric reality; the burden of the non-visible “genetic risk” and other clinical aspects that go beyond the mere visualization of the heart, may provide an holistic assessment that leads the way toward personalized medicine.

      Abstract

      Tiresias was the blind prophet of Apollo in Thebes. Tiresias is a symbolic figure, which embodies a paradox: he is blind in the physical sense, but his knowledge surpasses all, as opposed to Oedipus who cannot see despite having a good eyesight. Cardiac imaging can be considered the technological extension of human eyes, which has clearly revolutionised the diagnostic approach in Cardiology and specifically in heart failure. Echocardiography contributed to an approach focused on the ejection fraction (EF) which is the cornerstone of the most recent classifications of heart failure. The recent advances in cardiac imaging raised our ability to understand the aetiological roots of disease. However, the increasing amount of information generated by the plethora of diagnostic imaging techniques raises the challenge of clinical significance. The explosion of “big data” in cardiac imaging may also impact on classifications and nomenclature and on our ability to cluster and categorize, an exercise that is becoming remarkably challenging when the quest for the particular is taken to the extreme and the infinitesimal. The essence of cardiac conditions causing heart failure would probably not entirely captured by an approach only focused on the direct visualization of the heart. Delivery of personalized medicine would not be based only on cardiac imaging, but through an holistic approach which overcomes the mere assessment of empiric reality as it appears to our eyes through the lens of increasingly advanced diagnostic techniques.
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