AI Article Synopsis
- International Guidelines use left ventricular ejection fraction (LVEF) to classify heart failure patients and determine treatments, but LVEF has technical limitations and may not predict outcomes in advanced cases.
- Analysis of left ventricular flow metrics and non-invasive pressure evaluations can provide better prognostic insights for heart failure patients.
- Speckle tracking echocardiography (STE) effectively reveals underlying myocardial dysfunction, particularly in patients with preserved LVEF, and offers valuable metrics like global peak atrial longitudinal strain (PALS) for assessing left ventricular filling pressure and function.*
Article Abstract
International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11189326 | PMC |
| http://dx.doi.org/10.1007/s10741-024-10398-7 | DOI Listing |
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