ABSTRACT
BACKGROUND: The diagnosis of heart failure with preserved ejection fraction is characterized by its complexity, especially for physicians without great experience in comprehensive transthoracic Doppler echocardiography. Peak mitral E-wave (E) velocity has been successfully correlated to invasive left ventricular diastolic pressures in patients with structural heart disease. The aim of the study was to address the accuracy of E in the diagnosis of heart failure with preserved ejection fraction in elderly patients with acute dyspnea. METHODS: This prospective study included 29 consecutive patients ≥70 years of age with heart failure with preserved ejection fraction and acute dyspnea and 29 controls ≥70 years of age. The final diagnosis was supported by the 2016 ASE/EACVI recommendations. RESULTS: Mean age of the overall population was 85±7 years. E was strongly correlated with left atrial volume index (r=0.72, P<0.001) and with peak velocity of tricuspid regurgitation (r=0.77, P<0.001). E >85cm/s was 90% sensitive and 93% specific in the diagnosis of heart failure with preserved ejection fraction (AUC, 0.95). E/e' (0.95) and E/(e'xs') (0.92) did not perform better. CONCLUSION: E/e' and E/(e'xs') provide essential diagnostic and prognostic information in heart failure with preserved ejection fraction and deserve to be included in every report of comprehensive transthoracic Doppler echocardiography. E velocity is a very simple and user-friendly parameter that can be used for the sole diagnostic purpose in elderly patients with acute dyspnea by operators without great deal of experience, such as cardiologists without formal training, emergency physicians, intensive care anesthetists, internists and geriatricians.
Subject(s)
Heart Failure , Ventricular Function, Left , Aged , Aged, 80 and over , Dyspnea/etiology , Heart Failure/diagnosis , Humans , Prospective Studies , Stroke VolumeABSTRACT
Heart failure is accompanied by major disturbances of the functioning of the sympathetic nervous system: global overactivation and local modifications of the adrenergic system. 123I-MIBG cardiac scintigraphy is an isotope technique investigating presynaptic adrenergic function. The cardiac uptake of MIBG is decreased during heart failure, reflecting a reduction of norepinephrine reuptake by cardiac presynaptic nerve endings. Alteration of presynaptic function occurs early and plays an important role in the pathogenesis of the deterioration of heart failure. 123I-MIBG cardiac scintigraphy allows in vivo assessment of the myocardial adrenergic reserves of patients with congestive heart failure. It should be proposed in all patients with severe ventricular dysfunction to help define the indications for heart transplantation.
Subject(s)
Heart Failure/diagnostic imaging , Heart/diagnostic imaging , Iodine Radioisotopes , Iodobenzenes , 3-Iodobenzylguanidine , Contrast Media , Humans , Radionuclide ImagingABSTRACT
The decision to perform myocardial revascularization in patients with chronic ischaemic heart disease or following infarction, is based on many criteria such as coronary anatomy, left ventricular function, the clinical context and the patient's physiological age. It is also essential to confirm the presence of ischaemic but viable myocardium in the territory concerned by the revascularization. Functional imaging techniques allow the demonstration of this hibernating myocardium: thallium 201 myocardial tomoscintigraphy provides the clinician with a reliable answer in the great majority of cases. A number of examination protocols have been developed in order to make this investigation more efficient: late films, reinjection, etc. New tracers of viability are also currently under evaluation. Positron emission tomography (PET) is currently considered to be the reference technique for the detection of viable myocardium. Numerous tracers are used and this technique allows parallel evaluation of cellular metabolism and myocardial perfusion. Unfortunately, this type of investigation is expensive and not widely available. The use of positron emitter isotopes with conventional cameras appears to give encouraging results. Finally, among the other functional imaging devices, stress ultrasonography gives good results in the detection of hibernating myocardium. Contrast ultrasonography and magnetic resonance imaging are currently under development.
