The original objective of this question was to see if various imaging techniques (including cardiac MRI and bone scintigraphy using DPD tracing), when used following echocardiography, could identify a particular subset of people with HFPEF caused by amyloidosis. Amyloidosis accounts for around 5-13% of cases with HFPEF. The committee noted that during scoping for the guideline, it was thought that the amyloidosis question would complete the diagnostic picture, sitting alongside general recommendations on cardiac MRI imaging for HF. However, as no evidence was identified for the effectiveness of cardiac MRI in improving outcomes for HF patients, the committee decided that it would not be necessary for the guideline to specifically consider secondary imaging for a relatively narrow subset of patients with HFPEF. The committee noted that future research addressing the research recommendation including the OUTSMART 255 trial should answer the question on whether cardiac MRI in HF patients is clinically and cost- effective. Once this area of uncertainty is resolved for the general HF population, depending on the outcome of that research, it may then be appropriate to consider whether other forms of secondary imaging are effective in specific subpopulations of HF. If cardiac MRI were, in the future, to become a standard first line imaging technique for all HF patients, secondary imaging specific to amyloidosis may not be necessary (or may be used more judiciously in people with suspicious cardiac MRI results). However, until the effectiveness of cardiac MRI is known, the committee agreed that to conduct a review and make guideline recommendations specific to amyloidosis would be premature. Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 