Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application

Abstract

Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

“… 64 Assessment of these flow dynamics with cardiac imaging has been performed by CMRI and with TTE with colour Doppler flow mapping. 65 Following CRT implantation in responders, the longitudinal re‐alignment of haemodynamic forces towards the main axis of the left ventricle occurs, as is seen in patients without HF. This restoration of alignment is not present in CRT non‐responders or when biventricular pacing is stopped in responders.…”

“…Within the left ventricle, the formation of vortices is instrumental in blood flow dynamics 64 . Assessment of these flow dynamics with cardiac imaging has been performed by CMRI and with TTE with colour Doppler flow mapping 65 . Following CRT implantation in responders, the longitudinal re‐alignment of haemodynamic forces towards the main axis of the left ventricle occurs, as is seen in patients without HF.…”

Four-Dimensional XStrain Echocardiographic Assessment of Left Ventricular Strain and Rotational Mechanics: Technology, Clinical Applications, Advantages and Limitations

“…The LV vortex is a flow structure with a circular or swirling motion that preserves the momentum of late transmitral flow into the LV outflow tract during the transition from diastole to systole. A pathophysiological link between diastolic filling and systolic ejection can be identified with LV vortex flow [47].…”

“…LV vortex is an important predictor of adverse outcomes in patients with heart failure [47]. The HyperDoppler technique is a newer method for analysis of LV vortex formation (Figures 18 and 19), in which LV contractile function is investigated in a different manner [47].…”

Exercise Training: The Holistic Approach in Cardiovascular Prevention

“…The core component of cardiac rehabilitation is the assessment of patient' class of risk [69] together with dietary advice [70,71], educational intervention [72,73], psychological support [74], exercise training [75] and therapy management [69]. Nowadays great progresses have been made in drug therapy [76][77][78][79][80], devices [81][82][83][84][85][86], and diagnostic technologies [87][88][89][90], which allow for an even greater reduction of some risk factors. However, to further reduce risk of new CV events, it is important to act not only on optimization of therapy and its adherence, but also on other risk factors such as OB and lifestyle [91][92][93].…”