Structural and myocardial dysfunction in heart failure beyond ejection fraction
- PDF / 553,374 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 78 Downloads / 176 Views
Structural and myocardial dysfunction in heart failure beyond ejection fraction Paolo Severino 1 & Viviana Mestrini 1 & Marco Valerio Mariani 1 & Lucia Ilaria Birtolo 1 & Rossana Scarpati 1 & Massimo Mancone 1 & Francesco Fedele 1
# The Author(s) 2019
Abstract Heart failure is a multifaceted syndrome addressing for a high rate of death among the general population. The common approach to this disease has been always based on the evaluation of the left ventricular ejection fraction by two-dimensional echocardiography with Simpson’s method. Mounting evidences have demonstrated the pitfalls of this method and have suggested that the management of heart failure requires a deep knowledge of the pathophysiological insights of the disease and cannot rely only on the evaluation of the left ventricular ejection fraction. Several advanced imaging technologies overwhelm the evaluation of ejection fraction and could provide a better understanding of the myocardial abnormalities underlying heart failure. Considering the limitation of left ventricular ejection fraction and the systemic involvement of heart failure, classifications of heart failure based on ejection fraction should be substituted with a comprehensive “staging” of multiorgan damage, not only considering the heart but also the lungs, kidneys, and liver, such as the HLM staging system. Such a holistic approach based on the HLM staging system and multimodality imaging can provide a global assessment of patient features allowing for targeted therapies and better heart failure management. Keywords Heart failure . Ejection fraction . Imaging . Classification
Introduction Heart failure (HF) is a complex clinical syndrome related to a wide spectrum of left ventricular function abnormalities. Nowadays, HF is one of the most common causes of hospitalization and death with great impact on social and economic resources [1]. During the past decades, physicians endeavored to classify HF in order to improve the understanding of this multifaceted syndrome and best serve the needs of patients. Starting from the assumption of HF as a mechanical dysfunction of the heart, the measure of left ventricular (LV) function as the fraction of the LV end-diastolic volume ejected per beat was considered the best parameter for the detection and management of heart abnormalities. Firstly, Folse and Braunwald used a radioisotope indicator dilution technique [2] to estimate LV function; later, Bartle et al. [3] assessed
* Francesco Fedele [email protected] 1
Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
angiographically LV function and the term left ventricular ejection fraction (LVEF) was coined. More recently, the development of two-dimensional echocardiography allowed the use of LVEF as a primary measure of left ventricular function and heralded the widespread adoption of LVEF-based classification of HF. In 2012, the European Society of Cardiology HF guidelines [4] proposed a classificatio
Data Loading...
