echocardiography in heart failure

Last reviewed 01/2018

  • procedure is indicated in all patients in whom a new diagnosis of heart failure is made
  • causes of 'systolic heart failure' (global dyskinesis of the left ventricle) that may be identified include:
    • severe ischaemic heart disease and previous infarctions
    • dilated cardiomyopathy
  • causes of 'diastolic heart failure' include:
    • where there normal dimension of LV cavity and normal systolic function. However the ventricular walls are thickened and there are abnormal patterns of diastolic filling e.g. poor compliance of an inelastic ventricle, hypertrophied ventricle in a patient with chronic hypertension
    • where there is impaired diastolic function as a result of restricted diastolic filling e.g. restrictive cardiomyopathy, constrictive pericarditis, infiltrative disorders e.g. amyloid
  • patients with systolic dysfunction and preserved systolic function can be distinguished by measuring the left ventricular ejection fraction
    • cut off values may be arbitrary but if the value is >45-50% the ejection fraction is said to be normal
  • in patients with preserved systolic function, echocardiography will reveal
    • normal or only mildly abnormal LV systolic function (LVEF >= 45–50%)
    • evidence of diastolic dysfunction (abnormal left ventricular relaxation or diastolic stiffness) (1)