New imaging techniques in the diagnosis of heart failure with preserved ejection fraction
E.K. Serezhina1, A.G. Obrezan1,2,
1IMC SOGAZ LLC, St. Petersburg
2St. Petersburg State University
At the present day, heart failure (HF) is one of the most common cardiac pathologies, the frequency of which has been increasing over the past decades. The theory prevails that HF is not the only syndrome, but rather represented by two pathological processes — systolic and diastolic dysfunction. Nowadays, the differentiation between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) is based on the ejection fraction (EF) measurement by Doppler echocardiography. However, in contrast with EF measurement, new and more valid criteria for the systolic function assessment appear by virtue of cardiac function assessment, such as the long-axis strain rate measurement and tissue Doppler imaging. The in-depth techniques presented in this review, such as pulse-wave tissue Doppler, 2D and 3D speckle tracking echocardiography, allow you to: identify changes in myocardial contractility and deformity, determine early systolic and diastolic dysfunction, assess the risks of both hospitalization and death due to cardiac causes, and calculate the prognosis for patients with HFpEF. Thus, HFpEF in the current stage can be viewed both as by virtue of different characteristics of hemodynamic response and the longitudinal left ventricular (LV) contractile dysfunction, and by the LVEF analysis separately from the LV kinetics.
Keywords: heart failure, preserved ejection fraction, echocardiography, tissue Doppler, speckle tracking, deformation.
For citation: Serezhina E.K., Obrezan A.G. New imaging techniques in the diagnosis of heart failure with preserved ejection fraction. RMJ. Medical Review. 2019;1(II):52–56.
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4. Baicu C.F., Zile M.R., Aurigemma G.P., Gaasch W.H. Left ventricular systolic performance, function, and contractility in patients with diastolic heart failure. Circulation. 2005;111:2306–2312.
5. Yip G., Wang M., Zhang Y. et al. Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole: time for a redefinition? Heart. 2002;87:121–125.
6. Brutsaert D.L., De Keulenaer G.W. Diastolic heart failure: a myth. Curr Opin Cardiol. 2006;21(3):240–248.
7. Ponikowski P., Voors A.A., Anker S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–2200.
8. Pieske B. Diagnosing heart failure with preserved ejection fraction: The new HFA consensus. (Electronic resource). URL: https://www.escardio.org/Congresses-and-Events/Heart-Failure/Congress-resources/News/diagnosing-heart-failure-with-preserved-ejection-fraction-the-new-hfa-consensus (access date 01.02.2019).
9. Flachskampf F.A. Praxis der Echokardiographie. 2nd ed. Stuttgart, Germany: Georg Thieme Verlag KG; 2007.
10. Rademakers F.E., Bogaret J. Left Ventricular Myocardial Tagging. Int J Cardiac Imaging. 1997;13:233–245.
11. Kheradvar A., Assadi R., Falahatpisheh A., Sengupta P.P. Assessmnt of transmitral vortex formation in patients with diastolic dysfunction. J Am Soc Echocardiogr. 2012;25(2):220–227. DOI: 10.1016/j.echo.2011.10.003.
12. Mora V., Roldán I, Romero E. et al. Comprehensive assessment of left ventricular myocardial function by two-dimensional speckle-tracking echocardiography. Cardiovasc Ultrasound. 2018;16:16. DOI: 10.1186/s12947-018-0135-x.
13. Wang J., Khoury D.S., Yue Y. et al. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J. 2008;29:1283–1289. DOI: 10.1093/eurheartj/ehn141.
14. Russel I.K., Götte M.J.W., Bronzwaer J.G. et al. Left ventricular torsion. An expanding role in the analysis of myocardial dysfunction. J Am Coll Cardiol Img. 2009;2:648–655. DOI: 10.1016/j.jcmg.2009.03.001.
15. CutrÌ E., Serrani M., Bagnoli P. et al. The cardiac torsion as a sensitive index of heart pathology: a model study. J Mech Behav Biomed Mater. 2010;55:104–119. DOI: 10.1016/j.jmbbm.2015.10.009.
16. Marcelli E., Cercenelli L., Musaico M. et al. Assessment of cardiac rotation by means of gyroscopic sensors. Comput In Cardiol. 2008;35:389–392.
17. Esch B.T., Warburton D.E.R. Left ventricular torsion and recoil: implications for exercise performance and cardiovascular disease. J Appl Physiol. 2009;106(2):362–369. DOI: 10.1152/japplphysiol.00144.2008.
18. Cutrì E., Bagnoli P., Marcelli E. et al. A mechanical simulator of cardiac wall kinematics. ASAIO J. 2010;56(3):164–171. DOI: 10.1097/MAT.0b013e3181d7db0c.
19. Paulus W.J., Tschöpe C., Sanderson J.E. et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–2550.
20. Westermann D., Kasner M., Steendijk P. et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008;117(16):2051–2060.
21. Lester S.J., Tajik A.J., Nishimura R.A. et al. Unlocking the mysteries of diastolic function deciphering the rosetta stone 10 years later. J Am Coll Cardiol. 2008;51:679–689.
22. Yu C.M., Lin H., Ho P.C., Yang H. Assessment of left and right ventricular systolic and diastolic synchronicity in normal subjects by tissue Doppler echocardiography and the effects of age and heart rate. Echocardiography. 2003;20:19–27.
23. Sanderson J.E., Wang, M., Yu C.M. Tissue Doppler imaging for predicting outcome in patients with cardiovascular disease. Curr Opin Cardiol. 2004;19:458–463.
24. Correale M., Totaro A., Riccardo I. et al. Tissue Doppler Imaging in Coronary Artery Diseases and Heart Failure. Curr Cardiol Rev. 2012;8(1):43–53.
25. Henein M.Y., Gibson D.G. Long axis function in disease. Heart. 1999;81:229–231.
26. Alam M., Wardell J., Andersson E., Samad B.A., Nordlander R. Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave Doppler tissue imaging. J Am Soc Echocardiogr. 2000;13:343–352.
27. Sanderson J.E. Heart failure with a normal ejection fraction. Heart. 2007;93:155–158.
28. Nagueh S.F., Bachinski L.L., Meyer D. et al. Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation. 2001;104:128–130.
29. Van de Veire N.R., Yu C.M., Ajmone-Marsan N. et al. Triplane tissue Doppler imaging: a novel three-dimensional imaging modality that predicts reverse left ventricular remodelling after cardiac resynchronisation therapy. Heart. 2008;94(3):9.
30. Kjaergaard J., Hassager C., Oh J.K. et al. Measurement of cardiac time intervals by Doppler tissue M-mode imaging of the anterior mitral leaflet. J Am Soc Echocardiogr. 2005;18(10):1058–1065.
31. Biering-Sørensen T., Mogelvang R., Pedersen S. et al. Usefulness of the myocardial performance index determined by tissue Doppler imaging m-mode for predicting mortality in the general population. Am J Cardiol. 2011;107(3):478–483. DOI: 10.1016/j.amjcard.2010.09.044.
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