title: Prognostic markers in the pathology of cardiac failure: echocardiography and autonomic nervous system dysfunction.
abstract: BACKGROUND
  Chronic heart failure is a major health problem worldwide and despite the therapeutic advances, the mortality and morbidity still remain high. Echocardiography is the gold standard for left ventricular function assessment and may provide prognostic information for predicting future heart failure events.
  
  
  METHODS
  We analyzed the main echocardiographic markers used for the prognostic of chronic heart failure patients such as the ejection fraction, diastolic impairment and the collapse of inferior vena cava. Also, another parameter is studied, recently recognized as a marker for future cardiac events: autonomic nervous dysfunction. The current paper makes a comprehensive approach of the echocardiographic markers recommended for the diagnosis and follow-up of heart failure adapted to what we really find in our everyday practice with a correct patient management in a clinical and biological context. Even though left ventricle ejection fraction is the most often used parameter for cardiac failure follow-up and prognostic, new and more accurate parameters should be used: Tissue Doppler Imaging and Heart rate recovery - which may become a therapeutic target in the era of cardiac rehabilitation.
  
  
  CONCLUSIONS
  There is no stand-alone marker for the assessment of cardiac failure; each of the parameters presented has its advantages and its pitfalls. Echocardiography allows a morphologic study, which should always be correlated with clinical and functional studies (exercise stress test and autonomic nervous system dysfunction).
authors.affiliation: Laboratory of Cardiovascular Noninvasive Investigations, "Dr. Carol Davila" Central Military University Hospital, Bucharest, Romania; silviu.stanciu@yahoo.com.
authors.forename: Elena Cristina
authors.initials: EC
authors.lastname: Enciu
authors.forename: Silviu Marcel
authors.initials: SM
authors.lastname: Stanciu
authors.forename: Dumitru
authors.initials: D
authors.lastname: Matei
authors.forename: Adrian
authors.initials: A
authors.lastname: Costache
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D003971:Diastole; D004452:Echocardiography; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D013318:Stroke Volume