Echocardiography in Acute Heart Failure: Current Perspectives
Lampros Papadimitriou1, Vasiliki V Georgiopoulou2, Smadar Kort1
1Division of Cardiology, Stony Brook University, Stony Brook, New York.
Insights
Echocardiography is valuable for diagnosing acute heart failure (AHF) but its optimal use, including timing and specific measures for treatment response and risk stratification, requires further investigation. Current evidence supports its role but highlights knowledge gaps for patient phenotyping and intervention selection in AHF.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Echocardiography is recommended for diagnosing acute heart failure (AHF) but its application in AHF is less defined than in chronic heart failure.
- Despite being the primary imaging modality for AHF, echocardiography presents unique clinical challenges.
Purpose of the Study:
- To appraise the current evidence for echocardiographic measures in AHF.
- To identify knowledge gaps in the optimal use of echocardiography for AHF.
- To assess echocardiography's role in prognosis determination and risk stratification for AHF patients.
Main Methods:
- Review of current clinical guidelines and early-phase clinical studies.
- Analysis of data on echocardiographic endpoints as surrogate markers for treatment response.
- Evaluation of studies linking echocardiographic measures to post-discharge prognosis.
Main Results:
- Echocardiographic endpoints show promise as surrogate markers for tracking treatment response in AHF.
- Optimal timing and selection of echocardiographic measures for AHF are under active investigation.
- The utility of echocardiography for patient classification, risk stratification, and phenotyping for interventions in AHF remains less defined.
Conclusions:
- Echocardiography is a crucial diagnostic tool in AHF, but further research is needed to optimize its use.
- Knowledge gaps exist regarding the precise role of echocardiography in guiding AHF management and predicting outcomes.
- More investigation is required to establish echocardiography's utility for phenotyping and selecting AHF patients for specific interventions.
Abstract:
In contrast to chronic heart failure (HF), the use of echocardiography in acute HF (AHF) is less well defined, both in clinical practice and in clinical trials. Current guidelines recommend the utility of echocardiography as an adjunct diagnostic tool in the clinical setting of new-onset or decompensated HF. However, despite its unique advantages as the only practical imaging modality in AHF, echocardiography poses unique challenges in this setting. Data from early-phase clinical studies and trials provide evidence that echocardiographic end points can be clinically meaningful surrogate end points as a means to track response to treatment in AHF; however, the optimal timing and selection of echocardiographic measures is under active investigation. In addition, despite a number of studies indicating that certain echocardiographic measures of cardiac function are predictive of post-discharge prognosis, the role of echocardiography as a tool for patient classification and risk determination in AHF is less well defined. Importantly, it is unclear whether echocardiography can be used to phenotype and select AHF patients for interventions. In this article, we (1) appraise the current evidence for use of echocardiographic measures in AHF, (2) identify knowledge gaps regarding optimal use of echocardiography in AHF, and (3) assess the evidence for echocardiography as a prognosis determination and risk stratification tool in AHF.
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