Central role of echocardiography in the diagnosis and assessment of heart failure

CHEESMAN, MARK; Leech, G; Chambers, John; Monaghan, Mark; Nihoyannopoulos, Petros

doi:10.1136/hrt.80.2008.1s

Cited by 104 publications

(5 citation statements)

References 47 publications

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“…Echocardiography is now widely recommended and established as part of the clinical management of patients with HF [1,2]. LV end‐systolic volume (LVESV) [3], ejection fraction (EF) [4–6] and change in EF [5,7,8] are important prognostic indicators in HF.…”

Section: Introductionmentioning

confidence: 99%

Effect of tissue harmonic imaging and contrast upon between observer and test–retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure

Whalley

Gamble

Walsh

et al. 2004

European J of Heart Fail

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Aims: To investigate the effects of tissue harmonic imaging (THI) and contrast chamber opacification (LVO) upon measurement variability and reproducibility of echocardiographic left ventricular (LV) volume and ejection fraction (EF) measurements in patients with heart failure (HF). Background: Echocardiography is often used in HF patients to determine LV volumes and EF. However, current echo methods are variable and may not be applicable for repeat testing in individual patients. THI and LVO have both been shown to improve endocardial visualisation, but it remains to be determined whether this results in better measurement reproducibility. Methods: Thirty-one HF patients and 30 control subjects underwent echocardiography on two separate days. LV volumes were measured under four different imaging conditions: fundamental, THI, LVO and LVO with ECGtriggered Power Doppler. Chamber opacification, pulmonary transit time (PTT), endocardial enhancement, reproducibility and bias were assessed. Results: Chamber opacification was inferior and the PTT longer in the HF patients. PTT was related to LV volumes, EF, jugular venous pressure and mitral filling pattern. THI improved endocardial visualisation, and although LVO improved endocardial visualisation in the controls, it offered no benefit over THI in the HF patients. LV volumes and EF were different for each method and THI was the least variable method for repeat measurements. Conclusions: THI improved endocardial visualisation and was the least variable of the techniques. LVO offered no further advantage in patients with HF and thus cannot be routinely advocated and since LV volumes and EF were different for each, these methods are neither comparable nor interchangeable for follow-up assessments.

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Section: Introductionmentioning

confidence: 99%

Effect of tissue harmonic imaging and contrast upon between observer and test–retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure

Whalley

Gamble

Walsh

et al. 2004

European J of Heart Fail

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“…This The question is: why should we be interested in measuring LVDD from CTCA data since both TTE and cardiac MRI [25][26][27][28] are well recognised and widely available techniques that already do this well? Achenbach et al 29 posed such a question in their editor's page for the Journal of the American College of Cardiology Cardiovascular Imaging entitled 'Climbing Mount Everest "Because It's There"' in response to Boogers et al paper on feasibility of LVDD assessment with cardiac CT. 15 It was then agreed that additional information on DD may add to the growing list on noncoronary applications of cardiac CT.…”

Section: Discussionmentioning

confidence: 99%

Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

et al. 2021

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ObjectiveTo determine whether Computed Tomography (CT) coronary angiography (CTCA) has clinical value for the assessment of left ventricular (LV) diastolic dysfunction (DD) beyond traditional information on coronary artery anatomy.MethodIn this retrospective study, a consecutive group of 72 patients (mean age 59±13 years)—who met the eligibility criteria of sinus rhythm, no significant valvular abnormalities, and who had transthoracic echocardiogram (TTE)—were analysed. The CTCA was prospectively triggered during diastole. Outcomes of interest were CTCA derived LV and left atrial (LA) volumes, diastolic expansion (DE) index: LV volume÷LA volume and DE fraction (DEF): [(LV volume–LA volume)÷LV volume]×100. TTE-LA volume was measured as maximum, minimum and pre-A. Studied patients were divided according to the current classification of LVDD as a reference standard. A small subgroup of nine patients underwent further invasive cardiac catheterisation.ResultsCTCA-LV and LA volumes were larger compared with TTE, 37%±20% and 11%±21%, respectively. CTCA-LA volume correlated well with all TTE-LA volumes (maximum: R2=0.58; pre-A wave: R2=0.39; minimum: R2=0.26; p<0.0001) with the smallest differences in maximum LA volume (9±32 mL; mean±2 SD). The DE and DEF correlated with both LA function and LVDD. DE >1.65 and DE <1.40 have good specificity (85% and 88%, respectively), and positive predictive value to differentiate LVDD. DE and DEF were dependent on the patients’ age but independent of other variables.ConclusionsCTCA derived diastasis volume indices can provide additional quantifiable information on LVDD.

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“…The evidence from 4S prompted us to move away from TC reference ranges and adopt an action limit of below 5.2 mmol/l for the coronary cholesterol clinic treating secondary prevention patients in the Manor Hospital, Walsall [11]. The significant CVD risk reduction observed in 4S was replicated in many other intervention trial studies [12][13][14][15][16][17][18].…”

Section: Low Density Lipoprotein-cholesterol and Cardiovascular Diseasementioning

confidence: 99%

“…Following these intervention trials, the Joint British Societies (JBS) and European Atherosclerosis Society recommended secondary prevention treatment targets of TC < 5 mmol/l and/or LDL-c < 3 mmol/l in 1998 [12,18]. More recent studies clearly demonstrate that "lower is better" regards TC and LDL-c levels [14,17,19].…”

Section: Low Density Lipoprotein-cholesterol and Cardiovascular Diseasementioning

confidence: 99%

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

Ramachandran

König

Hackett

et al. 2018

Journal of Engineering and Science in Medical Diagnostics and Therapy

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The use of reference ranges is well established in medical practice and research. Classically, a range would be derived from the local healthy population and matched in age, gender, and other characteristics to the patients under investigation. However, recruiting suitable controls is problematic and the derivation of the range by excluding 2.5% at each end of the distribution results in 5% of the values being arbitrarily discarded. Thus, the traditional reference range is derived using statistical and not clinical principles. While these considerations are recognized by clinicians, it is often not realized that the application of whole population derived reference ranges to complex pathologies that comprise patient subgroups may be problematic. Such subgroups may be identified by phenotypes including genetic etiology, variations in exposure to a causative agent, and tumor site. In this review, we provide examples of how subgroups can be identified in diverse pathologies and how better management can be achieved using evidence-based action limits rather than reference ranges. We give examples from our clinical experience of problems arising from using the wrong reference ranges for the clinical situation. Identifying subgroups will often enable clinicians to derive specific action limits for treatment that will lead to customized management and researchers a route into the study of complex pathologies.

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Central role of echocardiography in the diagnosis and assessment of heart failure

Cited by 104 publications

References 47 publications

Effect of tissue harmonic imaging and contrast upon between observer and test–retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure

Effect of tissue harmonic imaging and contrast upon between observer and test–retest reproducibility of left ventricular ejection fraction measurement in patients with heart failure

Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function

Managing Clinical Heterogeneity: An Argument for Benefit-Based Action Limits

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