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Basic and advanced echocardiography in advanced heart failure: an overview Maria Concetta Pastore 1 & Giulia Elena Mandoli 1 & Hatem Soliman Aboumarie 2 & Ciro Santoro 3 & Francesco Bandera 4 & Antonello D’Andrea 5 & Giovanni Benfari 6 & Roberta Esposito 3 & Vincenzo Evola 7 & Regina Sorrentino 3 & Paolo Cameli 8 & Serafina Valente 1 & Sergio Mondillo 1 & Maurizio Galderisi 3 & Matteo Cameli 1 & on behalf of the Working Group of Echocardiography of the Italian Society of Cardiology

# Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract Advanced chronic heart failure (ACHF) is the last phase in the evolution of heart failure and is characterized by high hospitalization and mortality rates and is refractory to medical therapy, therefore requiring more aggressive therapies, such as mechanical circulatory support or heart transplantation. Over the last years, the incidence of ACHF was continuously growing, together with the increase in population survival rates. Therefore, the early recognition of the transition to ACHF is of crucial importance in HF patients, which also helps in prognostication of such patients, since advanced therapeutic options are limited to selected patients and they also have some important risk implications. Echocardiography is the gold standard tool for the evaluation of patients with HF; moreover, the recent technological advances provided new structural and functional indices of the four cardiac chambers that showed to be comparable to advanced imaging or invasive hemodynamic parameters. This allows us to operate an accurate study of ACHF with first- and second-level echocardiographic techniques, which are now being integrated in daily clinical practice. The present review presents an overview of the currently available tools for the echocardiographic examination of patients with ACHF, with its advantages and limitations, based on the latest supporting evidences. Keywords Advanced heart failure . Echocardiography . LVAD . Speckle tracking . 3D echocardiography

Introduction Advanced chronic heart failure (ACHF) represents the final stage in the progression of heart failure (HF) [1]. It is characterized by the onset of symptoms at rest and is refractory to conventional medical therapy, corresponding to a New York Heart Association (NYHA) class IV—American Heart Association (AHA) stage D. ACHF is a severe condition * Maria Concetta Pastore [email protected] 1

Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy

2

Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK

3

Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy

4

Cardiology University Department, Heart Failure Unit, IRCCS, Policlinico San Donato, San Donato Milanese and Department of Biomedical Sciences for Health, University of Milano, Milan, Italy

which leads to recurrent hospitalizations for volume overload, rhythm disturbances and complications of the disease itself and its therapy,