[Hemodynamic assessment and prognostic data obtained by echography in cardiac insufficiency]

The evaluation and follow up of insufficiency are matters of "routine" echography. The relevant parameters allow an evaluation of the contractility of the left ventricle (LV), cardiac output, filling pressures, significance of mitral insufficiency (MI), pulmonary pressures, and volumes, and one of the aims is to be able to offer an exhaustive haemodynamic assessment without unnecessarily prolonging the length of the examination. Calculation of the LV ejection fraction is an unavoidable parameter (it is often the inclusion criterion in large studies), recently "rehabilitated" thanks to harmonic imaging. However, the dependence on this index with respect to load conditions, is in fact a very imperfect reflection of LV contractility. The calculation of systolic ejection volume with Doppler (for example from the outflow chamber diameter and sub aortic flow) is a better reflection of LV performance. In the same manner, analysis of the ascending slope of MI flow during isovolumetric contraction (dp/dt) recorded with continuous Doppler allows a reasonably reliable and simple approach to LV contractility, only slightly dependent on load conditions. Numerous parameters allow a reliable evaluation of LV filling pressures: this always relies on the transmitral flow morphology, which has been better interpreted for several years, possibly coupled with a recording of pulmonary venous flow, or even a colour TM mode recording of LV filling or a pulsed tissular Doppler flow recording at the mitral ring. Analysis of the right side of the heart consists of evaluation of the size of the cavities and quantification of the tricuspid flow. Even if the flow is not laminar, it allows a reliable measurement of the pulmonary pressures (by default, pulmonary flow is determined). TM recording in the inferior vena cava has to be systematic to allow evaluation of the right-sided pressures and volumes. Interpretation of these various parameters allows a subtle haemodynamic evaluation in severe cardiac insufficiency, for which the significance is not only diagnostic, but also prognostic: adverse effect of low LVEF; adverse effect of restrictive mitral flow (E/A ratio > 2 and in particular short E deceleration time less than 150 ms), especially if it is not modified by treatment.