Congestive heart failure echocardiography
 |
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]
Overview
Echocardiography is commonly used to diagnose and monitor the progress 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 reveal subclinical HF and predict risk of subsequent events.[1]
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.
2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [4][5]
Echocardiography in Patients Presenting With Heart Failure (DO NOT EDIT) [4][5]
| Class I |
| "1. Two-dimensional echocardiography with Doppler should be performed during initial evaluation of patients presenting with heart failure to assess left ventricular ejection fraction, left ventricular size, wall thickness, and valve function. Radionuclide ventriculography can be performed to assess left ventricular ejection fraction and volumes. (Level of Evidence: C) " |
| "2. Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy.(Level of Evidence: C) " |
| Class III (No Benefit) |
| "Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should not be performed.[6] (Level of Evidence: B)" |
Vote on and Suggest Revisions to the Current Guidelines
Sources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [4]
- 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation [5]
References
- ↑ Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J (2009). "Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers". J. Card. Fail. 15 (7): 586–92. doi:10.1016/j.cardfail.2009.03.002. PMID 19700135.
- ↑ Bonow RO, Bennett S, Casey DE, Ganiats TG, Hlatky MA, Konstam MA, Lambrew CT, Normand SL, Pina IL, Radford MJ, Smith AL, Stevenson LW, Burke G, Eagle KA, Krumholz HM, Linderbaum J, Masoudi FA, Ritchie JL, Rumsfeld JS, Spertus JA (2005). "ACC/AHA Clinical Performance Measures for Adults with Chronic Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures): endorsed by the Heart Failure Society of America". Circulation. 112 (12): 1853–87. doi:10.1161/CIRCULATIONAHA.105.170072. PMID 16160201.
- ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
- ↑ 4.0 4.1 4.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
- ↑ 5.0 5.1 5.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
- ↑ Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Ward RP, Weiner RB (2011). "ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians". J. Am. Coll. Cardiol. 57 (9): 1126–66. doi:10.1016/j.jacc.2010.11.002. PMID 21349406.