Echocardiography in the assessment of heart failure

Abstract

Echocardiography with Doppler is the most commonly performed non-invasive cardiac imaging test in patients with suspected or documented heart failure (HF), and plays a pivotal role in their assessment and management. Two- and three-dimensional echocardiography are commonly used to quantitatively assess cardiac volumes, left ventricular ejection fraction (LVEF), stroke volume and cardiac output. Resting and stress echocardiography the latter with exercise or pharmacologic stress play a fundamental role in distinguishing ischemic from non-ischemic etiology of HF and in demonstrating myocardial viability. Echocar-diography with comprehensive spectral and color Doppler can accurately determine if valve disease plays a primary or secondary role in HF etiology. Diastolic heart failure (DHF) also termed HF with a preserved LVEF is readily identified by echocardiography with Doppler, and can accurately estimated LV filling pressures and pulmonary artery pressures. The right ventricle can also be readily assessed by echocardiography, with newer techniques such as three-dimensional, tissue Doppler and speckle strain imaging aiding its assessment. Echocardiography is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Three-dimensional echocardiography now easily preformed with single-beat full volume capture promises to further refine HF diagnosis. Finally, speckle-based strain and strain rate, and three-dimensional speckle imaging, are more novel techniques that can shed light on detailed myocardial mechanics in patients with depressed or preserved LVEF.