Tops, Laurens F.Aimo, AlbertoAdamopoulos, StamatisBonios, MichaelÇelik, AhmetChioncel, OvidiuCikes, MajaCrespo-Leiro, María GenerosaDamman, KevinDi Nora, ConcettaDreyfus, JulienGustafsson, FinnHashmani, ShahrukhMasetti, MarcoMordi, IfyNalbantgil, SanemVan Laake, Linda W.von Bardeleben, Ralph StephanMetra, MarcoMoura, BrendaBen Gal, Tuvia2026-02-042026-02-042025-10-14Tops LF, Aimo A, Adamopoulos S, Bonios M, Çelik A, Chioncel O, Cikes M, Crespo-Leiro MG, Damman K, Di Nora C, Dreyfus J, Gustafsson F, Hashmani S, Masetti M, Mordi I, Nalbantgil S, van Laake LW, von Bardeleben RS, Metra M, Moura B, Ben Gal T. 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. Eur J Heart Fail. 2025 Nov;27(11):2557-2570.1388-9842https://hdl.handle.net/2183/47223Position paper[Abstract] This clinical consensus statement outlines the vital role of multimodality imaging in managing patients with advanced heart failure (HF), particularly those receiving mechanical circulatory support (MCS) and heart transplantation (HT). For both temporary and durable MCS, multimodality imaging, primarily echocardiography, is crucial for selecting candidates, ensuring proper device placement, and monitoring in the post-implantation period. Preoperatively, it helps to identify HF phenotypes, assess ventricular functions, detect intracardiac thrombi, and evaluate valvular conditions. Key measurements include ventricular size, ejection fraction, and cardiac output. Intraoperative imaging ensures optimal device placement and complication detection. Post-implantation echocardiography gives an impression of the interplay between heart and MCS, detects early complications, and evaluates ventricular unloading and right ventricular function. Serial imaging evaluations are essential for the management of the patient and the device and for diagnosing and treatment of complications. In temporary MCS, imaging is vital in the weaning process. Imaging is crucial across various post-transplant phases, from early postoperative monitoring to long-term follow-up. Echocardiography is the first-line technique. Cardiovascular magnetic resonance provides detailed evaluation of cardiac structure and function, offering insights into fibrosis, oedema, and myocardial perfusion. Coronary computed tomography angiography and positron emission tomography are possible alternatives for assessing coronary allograft vasculopathy. Overall, multimodality imaging is pivotal for comprehensive management of patients potentially eligible to or undergoing MCS or HT, enhancing diagnostic accuracy and guiding therapeutic decisions.engThis is a pre-copyedited, author-produced version of an article accepted for publication in [insert journal title] following peer review. The version of record is available online at https://doi.org/10.1002/ejhf.70018.Advanced heart failureCardiac allograft vasculopathyEchocardiographyHeart transplantationMechanical circulatory supportjournal articleembargoed access10.1002/ejhf.70018