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Assessment of ventricular function in dilated cardiomyopathies
Insights
Systolic dysfunction in dilated cardiomyopathy leads to heart failure. Accurate left ventricular function assessment, especially noninvasive methods, is crucial for evaluating new therapies and improving patient outcomes.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Systolic dysfunction in dilated cardiomyopathy causes heart failure with high mortality.
- Current therapies offer symptomatic relief but are inadequate for many patients.
Purpose of the Study:
- To review current methods for assessing left ventricular function.
- To highlight recent advances in noninvasive evaluation techniques.
Main Methods:
- Review of invasive pressure-volume relations as a gold standard.
- Discussion of newer noninvasive surrogates for assessing cardiac function.
- Focus on methods minimally influenced by vascular loading conditions.
Main Results:
- Invasive pressure-volume relations provide accurate, cardiac-specific assessments.
- Noninvasive methods offer practical alternatives for chronic disease management.
- Advances enable better evaluation of novel heart failure therapies.
Conclusions:
- Accurate left ventricular function assessment is vital for developing effective heart failure treatments.
- Noninvasive techniques are advancing, offering broader applicability in clinical settings.
- Improved assessment tools are key to reducing heart failure mortality.
Abstract:
Regardless of its cause, systolic dysfunction in dilated cardiomyopathy triggers a wide variety of compensatory responses resulting in cardiac dilatation, fluid retention, and systemic vasoconstriction. Standard therapy with vasodilators, digoxin, and diuretics can provide symptomatic relief in many patients. However, many others do not respond adequately, and mortality from heart failure remains high. This has driven the search for novel therapies. To evaluate the efficacy and decipher mechanisms of action of these treatments, accurate assessments of left ventricular function are valuable. In particular, one seeks indexes that are cardiac-specific, in that they are minimally influenced by vascular loading conditions. An increasingly used "gold standard" that can achieve this goal is the invasively measured pressure-volume relation. Newer noninvasive methods have yielded several surrogates that have the key advantage of being applicable to chronic disease assessment. In this report, we review the current state-of-the-art in left ventricular function assessment, and describe recent advances in its noninvasive evaluation.