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Review
. 2007 Oct 2:5:34.
doi: 10.1186/1476-7120-5-34.

Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction

Quirino Ciampi  1 , Bruno Villari
Affiliations
Review

Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction

Quirino Ciampi et al. Cardiovasc Ultrasound. .

Abstract

Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Echocardiography represents the "gold standard" in the assessment of LV systolic dysfunction and in the recognition of systolic heart failure, since dilatation of the LV results in alteration of intracardiac geometry and hemodynamics leading to increased morbidity and mortality. The functional mitral regurgitation is a consequence of adverse LV remodelling that occurs with a structurally normal valve and it is a marker of adverse prognosis. Diastolic dysfunction plays a major role in signs and symptoms of HF and in the risk stratification, and provides prognostic information independently in HF patients and impaired systolic function. Ultrasound lung comets are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction, which can integrate the clinical and pathophysiological information provided by conventional echocardiography and provide a useful information for prognostic stratification of HF patients. Contractile reserve is defined as the difference between values of an index of left ventricular contractility during peak stress and its baseline values and the presence of myocardial viability predicts a favorable outcome. A non-invasive echocardiographic method for the evaluation of force-frequency relationship has been proposed to assess the changes in contractility during stress echo. In conclusion, in HF patients, the evaluation of systolic, diastolic function and myocardial contractile reserve plays a fundamental role in the risk stratification. The highest risk is present in HF patients with a heart that is weak, big, noisy, stiff and wet.

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Figures

Figure 1
Figure 1
Algorithm of diagnosis of heart failure or left ventricular dysfunction.
Figure 2
Figure 2
Measurement of left ventricular end-diastolic diameter (EDD) and end-systolic diameter (ESD) from M-mode (down), guided by a parasternal short axis image (upper) to optimize medial-lateral beam orientation.
Figure 3
Figure 3
2-D measurements for volume calculations using the biplane method of discs (modified Simpson's rule), in the apical four-chamber (A4C) and apical two-chamber (A2C) views at end diastole (LV EDD) and at end-systole (LVESD). The papillary muscles should be excluded from the cavity in the tracing.
Figure 4
Figure 4
Role of stress echo viability in heart failure.
Figure 5
Figure 5
Transmitral LV filling pattern (up); mitral annulus pulsed Tissue Doppler velocity at septum (left panel) septal (down left) and lateral wall (down right) corner.
Figure 6
Figure 6
Transmitral LV filling pattern (up); mitral annulus pulsed Tissue Doppler velocity at septum (left panel) septal (down left) and lateral wall (down right) corner.
Figure 7
Figure 7
Role of echocardiography in the evaluation of risk in heart failure patients.
See this image and copyright information in PMC

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