New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Left ventricular ejection fraction (LVEF) is a standard parameter for heart failure (HF) classification and treatment guidance.
• LVEF has limitations, including geometric assumptions, inability to assess intrinsic myocardial function, and challenges in evaluating left ventricular filling pressure (LVFP).
• LVEF has shown limited prognostic value in advanced HF and cannot fully capture diastolic dysfunction.

Purpose of the Study:

• To review the limitations of LVEF in assessing heart failure.
• To highlight the benefits of a multiparametric hemodynamic approach for evaluating myocardial function in HF.
• To emphasize the role of advanced echocardiographic techniques in improving HF assessment.

Main Methods:

• Analysis of left ventricular (LV) antegrade flow parameters (stroke volume index, cardiac output) using pulsed-wave Doppler.
• Non-invasive evaluation of LV filling pressure (LVFP).
• Application of speckle tracking echocardiography (STE) for assessing intrinsic myocardial function, including global peak atrial longitudinal strain (PALS).

Main Results:

• LV antegrade flow analysis and non-invasive LVFP assessment show prognostic implications in HF.
• STE effectively identifies intrinsic myocardial dysfunction, especially in HF with preserved ejection fraction (HFpEF).
• Global PALS is a reliable indicator of LVFP, addressing gaps in diastolic dysfunction assessment and aiding HFpEF evaluation.

Conclusions:

• A multiparametric hemodynamic approach, incorporating LVFP and stroke volume, is crucial for comprehensive HF assessment.
• Advanced echocardiographic methods like STE and PALS overcome LVEF limitations.
• This integrated approach enhances the understanding and management of heart failure, particularly HFpEF.