Description
Non-invasive imaging, particularly echocardiography, plays a central role in the evaluation for heart failure with preserved ejection fraction (HFpEF). Echocardiography helps to rule in HFpEF among patients with unexplained dyspnea when the diagnosis is uncertain. In established HFpEF, echocardiography provides important insights into pathophysiology and phenotyping, such as isolated left ventricular diastolic dysfunction, left atrial dysfunction, abnormal right ventricular- pulmonary artery coupling, ischemia, or obesity phenotypes
Summary Listen
- Heart failure is a clinical syndrome characterized by symptoms and/or signs resulting from structural or functional cardiac abnormalities, corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. It is classified based on ejection fraction (EF): reduced (≤40%), mildly reduced (41-49%), and preserved (≥50%).
- Heart failure affects approximately 1-2% of adults in developed countries, with high mortality rates. In India, patients are younger (mean age 53 vs 73 globally) and experience higher in-hospital and post-discharge mortality. Coronary heart disease, valvular heart disease, and cardiomyopathies are the main causes.
- Cardiac structural abnormalities in heart failure result from injury and remodeling, leading to infarct zones, dilatation, increased interstitial collagen, myocyte hypertrophy, and fibrous scar formation. This remodeling process is often irreversible without intervention.
- Echocardiography is essential for assessing LV size, sphericity index, identifying fibrotic walls, and evaluating remodeling. It also guides fluid management, diuretic or inotrope use, beta-blocker administration, and the timing of coronary intervention.
- A case study was presented of a 49-year-old male with progressive dyspnea admitted with acute left ventricular failure. Echocardiography revealed dilated LV, poor EF, moderate mitral regurgitation, elevated pulmonary artery systolic pressure, and elevated LV filling pressures.
- Serial echocardiograms were used to guide treatment and monitor the patient's response. Improvements in EF, mitral regurgitation, and IVC diameter were observed with appropriate medical therapy, culminating in reverse remodeling and improved functional class.
- Ejection fraction (EF) is crucial, but not the sole determinant of outcome. Tissue Doppler imaging, global longitudinal strain (GLS), and Doppler parameters are also important. Lower EF is associated with higher mortality and heart failure hospitalization rates.
- Right ventricular ejection fraction (RVEF) and right ventricular dilatation are also important prognostic indicators. Tricuspid regurgitation and pulmonary pressures, as assessed by echocardiography, provide additional hemodynamic information.
- Global longitudinal strain (GLS) provides additional prognostic information, even in patients with mildly decreased EF. A 1% increase in GLS is associated with a 5% decrease in mortality risk.
- Echocardiography plays a key role in the diagnosis, treatment planning, monitoring, and prognostication of heart failure patients. It allows for a comprehensive evaluation of cardiac structure and function, aiding in informed decision-making and improved patient outcomes.
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