Prognostic implications of echocardiography in advanced heart failure.
OBJECTIVE
The growing epidemic of systolic congestive heart failure mandates strategies to identify accurately people with high morbidity and mortality. Echocardiography remains the most widely available noninvasive tool for the assessment of cardiac structure, function, and hemodynamics. Clinical data paired with echocardiographic analysis in patients with systolic heart failure obtained from a variety of investigations have allowed for the evaluation of this modality as a prognostic tool.


RESULTS
Detailed appraisal of the literature has revealed five distinct, easy-to-evaluate echocardiographic parameters that may assist clinicians to segregate high-risk patients. The presence of or the inability to modify a left ventricular ejection fraction less than 25%, impaired right ventricular function (assessed by any of four methods), left ventricular end-diastolic dimension greater than 6.5 to 7 cm, a restrictive mitral inflow, or pulmonary hypertension (peak tricuspid regurgitant velocity >2.5 m/s) should alert clinicians of patients with high morbidity (recurrent congestive heart failure admission, arrhythmia, impaired functional capacity) and mortality. Particularly important among these variables is the presence of a restrictive mitral inflow pattern.


CONCLUSIONS
Detailed analysis of two-dimensional and Doppler data routinely obtained from echocardiograms has established prognostic implications among patients with systolic heart failure. Although prospective clinical trials are lacking, the use of echocardiography to segregate risk should be incorporated into current strategies to treat congestive heart failure and influence clinical listing for cardiac transplantation.
Thohan
Vinay
V
DeBakey Heart Center, Winters Center for Heart Failure Research, Gene and Judy Campbell Laboratory for Cardiac Transplant Research, Baylor College of Medicine, and Methodist Hospital, Houston, Texas 77030, USA. vthohan@bcm.tmc.edu
D002302:Cardiac Output; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D011379:Prognosis; D012680:Sensitivity and Specificity