Congestive heart failure echocardiography
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Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2];Seyedmahdi Pahlavani, M.D. [3]
Overview
Echocardiography is commonly used to diagnose and monitor the progression of heart failure. This modality uses ultrasound to determine the stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat), the end-diastolic volume (EDV, the total amount of blood at the end of diastole), and the SV divided by the EDV, a value known as the ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function.
Abnormalities Detected / Evaluated on Echocardiography in Congestive Heart Failure
The most useful diagnostic test in the evaluation of patients with or at risk for HF (eg, postacute MI) is a comprehensive 2-dimensional echocardiogram; coupled with Doppler flow studies, the transthoracic echocardiogram can identify abnormalities of myocardium, heart valves, and pericardium. Echocardiography can detect subclinical HF and predict[1] risk of subsequent events.
LVEF is reduced, LV structure is abnormal, and other structural abnormalities are present that could account for the clinical presentation. This information should be
Echocardiography can be used in the following ways:
- To evaluate left ventricular function and ejection fraction to distinguish systolic dysfunction with a low ejection fraction (<40%) from diastolic dysfunction with a preserved ejection fraction.
- LV structural abnormalities
- To assess for the presence of regional wall motion abnormalities that would suggest an ischemic basis for the heart failure
- Detection and quantification of mitral regurgitation
- Detection and quantification oof aortic stenosis
- Measurement of pulmonary artery pressure
- Pericardial diseases such as cardiac tamponade can be rapidly diagnosed by echocardiography.
- Echocardiography may also aid in deciding what treatments will help the patient, such as medication, insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy.
Echocardiographic findings must be quantified, including numerical estimates of EF measurement, ventricular dimensions, wall thickness, calculations of ventricular volumes, and evaluation of chamber geometry and regional wall motion.
Documentation of LVEF is an HF quality-of-care performance measure.[2]
Right ventricular size and function as well as atrial size and dimensions should also be measured.
All valves should be evaluated for anatomic and flow abnormalities.
Many of these abnormalities are prognostically important and can be present without manifest HF.[3]
Serial echocardiographic evaluations are useful because evidence of cardiac reverse remodeling can provide important information in patients who have had a change in clinical status.
2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [4]
Evaluation With Cardiac Imaging 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [4]
| Class I |
| "2. In patients with suspected or newly diagnosed HF, transthoracic echocardiography (TTE) should be performed during initial evaluation to assess cardiac structure and function. [5] (Level of Evidence: C-LD) " |
| Class IIb |
"7. In patients with HF and coronary artery disease (CAD) who are candidates for coronary revascularization, noninvasive stress imaging (stress echocardiography, single-photon emission CT [SPECT], CMR, or positron emission tomography [PET] may be considered for detection of myocardial ischemia to help guide coronary revascularization. [6][7][8][9][10] (Level of Evidence:B-NR) "
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References
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