Evaluation of left ventricular stiffness with echocardiography

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Imaging

Background:

• Heart failure with preserved ejection fraction (HFpEF) affects half of all heart failure patients.
• Increased left ventricular (LV) stiffness is a key pathophysiological factor in HFpEF.
• Invasive measurement of LV stiffness is limited; noninvasive echocardiographic methods are under development.

Purpose of the Study:

• To review pathophysiological mechanisms of LV stiffness in HFpEF.
• To summarize echocardiography-derived indices for assessing LV chamber and myocardial stiffness.
• To discuss correlations with invasive measures, applications, and limitations of these noninvasive indices.

Main Methods:

• Review of existing literature on echocardiographic assessment of LV stiffness.
• Analysis of indices for LV chamber stiffness (e.g., E/e'/LVEDV, E/SRe/LVEDV, DPVQ, TVI).
• Analysis of indices for LV myocardial stiffness (e.g., DWS, iVP, SWI).

Main Results:

• Echocardiographic indices for LV chamber stiffness (E/e'/LVEDV, E/SRe/LVEDV, DPVQ) show moderate correlation with invasive measures due to reliance on LV filling pressure surrogates.
• Time-velocity integral (TVI) measurements show potential but require further validation.
• Echocardiographic indices for LV myocardial stiffness (DWS, iVP, SWI) have limitations; DWS may reflect overall cardiac function rather than pure stiffness.

Conclusions:

• Currently, no single echocardiography-derived index reliably assesses LV stiffness.
• Existing noninvasive methods for LV chamber and myocardial stiffness have limitations in accuracy and reliability.
• A comprehensive evaluation using multiple echocardiographic parameters may improve the detection of LV stiffness alterations.