From left ventricular ejection fraction to cardiac hemodynamics: role of echocardiography in evaluating patients with heart failure

Mele, Donato; Andrade, Aurora; Bettencourt, Paulo; Moura, Brenda; Pestelli, Gabriele; Ferrari, Roberto

doi:10.1007/s10741-019-09826-w

Cited by 32 publications

(29 citation statements)

References 60 publications

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“…For example, with a BSA of 1.8 m 2 , a stroke distance of 12 cm and a LVOTD of 27 mm, SVI is 38 ml/m 2 . Secondly, the accuracy of stroke distance has never been compared for assessing LV output with invasive measurement, whereas SV (or other LVOTD-including measures such as cardiac output) has shown high correlation with the invasive measurement in several studies (22)(23)(24)(25)(26)(27)(28)(29)(30)(31). In addition, comparing the usefulness of SVI and stroke distance as prognostic markers, a better stratification capability of SVI was shown in one study (16).…”

Section: Discussionmentioning

confidence: 99%

Indirect Ultrasound Evaluation of Left Ventricular Outflow Tract Diameter Implications for Heart Failure and Aortic Stenosis Severity Assessment.

Pestelli

Fiorencis

Pergola

et al. 2020

Preprint

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Background. Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity. Methods. A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N=340) independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N=200) and compared with the BSA-derived formula. Results. LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta=0.392, P<0.001), BSA (beta=0.229, P<0.001), LV end-diastolic diameter (LVEDD, beta=0.145, P=0.001), and height (beta=0.125, P=0.037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD=6.209+[0.201xSVD]+[1.802xBSA]+[0.03xLVEDD]+[0.025xHeight]) did not differ from (P=0.937) and was highly correlated with measured LVOTD (R=0.739, P<0.001) in the validation group. Repeated analysis with LV end-diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA-derived LVOTD values were different from measured LVOTD (P<0.001). Conclusion. Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS, avoiding use of LVOT velocity-time integral alone, which can be misleading, especially when LV cavity and aortic root dimensions are abnormal.

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Section: Discussionmentioning

confidence: 99%

Indirect Ultrasound Evaluation of Left Ventricular Outflow Tract Diameter Implications for Heart Failure and Aortic Stenosis Severity Assessment.

Pestelli

Fiorencis

Pergola

et al. 2020

Preprint

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“…EF is not a reliable measurement of longitudinal and torsional contraction although the whole systolic function results from all three variables. This reflects the different course and geometrical alignment of myocardial fibers that are not homogeneous inside the myocardial wall and in the different cardiac sites varying from basal to apical segments (45,46). Accordingly, several studies that included patients with preserved EF showed significant longitudinal global function impairment, despite an apparently normal systolic function (47,48).…”

Section: Limitations Related To Ef Assessmentmentioning

confidence: 99%

“…Although it is not strictly related to the real forward flow, EF is erroneously considered as an indicator for LV remodeling. Indeed, an enlargement of diastolic dimension works as a compensatory factor in order to maintain an adequate stroke volume even during the occurrence of dilated systolic volume (46,49). Conversely, in case of concentric remodeling, the stroke volume may be maintained although end diastolic volume is within the normal range and the ratio to systolic volume has altered.…”

Section: Limitations Related To Ef Assessmentmentioning

confidence: 99%

Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes

Palazzuoli

Beltrami

2021

Front. Cardiovasc. Med.

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Traditionally, patients with heart failure (HF) are divided according to ejection fraction (EF) threshold more or <50%. In 2016, the ESC guidelines introduced a new subgroup of HF patients including those subjects with EF ranging between 40 and 49% called heart failure with midrange EF (HFmrEF). This group is poorly represented in clinical trials, and it includes both patients with previous HFrEF having a good response to therapy and subjects with initial preserved EF appearance in which systolic function has been impaired. The categorization according to EF has recently been questioned because this variable is not really a representative of the myocardial contractile function and it could vary in relation to different hemodynamic conditions. Therefore, EF could significantly change over a short-term period and its measurement depends on the scan time course. Finally, although EF is widely recognized and measured worldwide, it has significant interobserver variability even in the most accredited echo laboratories. These assumptions imply that the same patient evaluated in different periods or by different physicians could be classified as HFmrEF or HFpEF. Thus, the two HF subtypes probably subtend different responses to the underlying pathophysiological mechanisms. Similarly, the adaptation to hemodynamic stimuli and to metabolic alterations could be different for different HF stages and periods. In this review, we analyze similarities and dissimilarities and we hypothesize that clinical and morphological characteristics of the two syndromes are not so discordant.

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“…Clinically, no clear relationship between EF and patient NYHA class can be found [7]. The distinction of 3 HF categories within the spectrum of EF, specifically separating HF with midrange ejection fraction (HFmrEF) -the "grey zone" group, has narrowed the ranges of both HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), thus improving the homogeneity of their phenotyping profiles [1].…”

Section: Echocardiography and Hf Classificationmentioning

confidence: 99%

Echocardiography in patients with heart failure: recent advances and future perspectives

Kosmala¹,

Marwick²,

Przewlocka‐Kosmala³

2021

Kardiol Pol

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From left ventricular ejection fraction to cardiac hemodynamics: role of echocardiography in evaluating patients with heart failure

Cited by 32 publications

References 60 publications

Indirect Ultrasound Evaluation of Left Ventricular Outflow Tract Diameter Implications for Heart Failure and Aortic Stenosis Severity Assessment.

Indirect Ultrasound Evaluation of Left Ventricular Outflow Tract Diameter Implications for Heart Failure and Aortic Stenosis Severity Assessment.

Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes

Echocardiography in patients with heart failure: recent advances and future perspectives

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