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Dhont S, Verbrugge FH, Verwerft J, Bertrand PB. Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024:zuae041. [PMID: 38683589 DOI: 10.1093/ehjacc/zuae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024]
Abstract
Non-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.
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Affiliation(s)
- Sebastiaan Dhont
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Verwerft
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Philippe B Bertrand
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
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Picano E, Pierard L, Peteiro J, Djordjevic-Dikic A, Sade LE, Cortigiani L, Van De Heyning CM, Celutkiene J, Gaibazzi N, Ciampi Q, Senior R, Neskovic AN, Henein M. The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. Eur Heart J Cardiovasc Imaging 2024; 25:e65-e90. [PMID: 37798126 DOI: 10.1093/ehjci/jead250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology of the National Research Council, CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Luc Pierard
- University of Liège, Walloon Region, Belgium
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Centre of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center UPMC Heart & Vascular Institute, Pittsburgh, PA, USA
| | | | | | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
| | - Roxy Senior
- Imperial College, UK
- Royal Brompton Hospital Imperial College London, UK
- Northwick Park Hospital, London, UK
| | - Aleksandar N Neskovic
- Department of Cardiology, University Clinical Hospital Center Zemun-Belgrade Faculty of Medicine, University of Belgrade, Serbia
| | - Michael Henein
- Department of Public Health and Clinical Medicine Units: Section of Medicine, Umea University, Umea, Sweden
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Vilela EM, Fontes-Carvalho R. Blood Pressure Response and Exercise Stress Echocardiography: New Perspectives on a Contemporary Challenge. Arq Bras Cardiol 2023; 120:e20230737. [PMID: 38126487 PMCID: PMC10763685 DOI: 10.36660/abc.20230737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Eduardo M. Vilela
- Serviço de CardiologiaCentro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal Serviço de Cardiologia , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia – Portugal
| | - Ricardo Fontes-Carvalho
- Serviço de CardiologiaCentro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal Serviço de Cardiologia , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia – Portugal
- Centro de Investigação CardiovascularFaculdade de MedicinaUniversidade do PortoPortoPortugal Centro de Investigação Cardiovascular , Faculdade de Medicina , Universidade do Porto , Porto – Portugal
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Gargani L, Girerd N, Platz E, Pellicori P, Stankovic I, Palazzuoli A, Pivetta E, Miglioranza MH, Soliman-Aboumarie H, Agricola E, Volpicelli G, Price S, Donal E, Cosyns B, Neskovic AN. Lung ultrasound in acute and chronic heart failure: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2023; 24:1569-1582. [PMID: 37450604 PMCID: PMC11032195 DOI: 10.1093/ehjci/jead169] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Paradisa 2 5614, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Nancy, France
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ivan Stankovic
- Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Italy
| | - Emanuele Pivetta
- Medicina d'Urgenza-MECAU, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, UK
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Susanna Price
- Departments of Cardiology & Intensive Care, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, Rennes, France
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
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Timofeeva TM, Kobalava ZD, Safarova AF, Cabello Montoya F. [Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction]. TERAPEVT ARKH 2023; 95:296-301. [PMID: 38158976 DOI: 10.26442/00403660.2023.04.202159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 01/03/2024]
Abstract
AIM To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period. MATERIALS AND METHODS Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF≥50%; ∆LV EF more than 5%, but LV EF<50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (2-4 B-lines), moderate (5-9 B-lines) and severe (≥10 B-lines). The end point was hospitalization for HF for 2.5 years. RESULTS Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF≥50% (in 13.4% of cases; p=0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines ≥10 on exercise (relative risk 7.45; 95% confidence interval 2.55-21.79; p<0.000). CONCLUSION Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period.
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Affiliation(s)
- T M Timofeeva
- People's Friendship University of Russia (RUDN University)
- Vinogradov City Clinical Hospital
| | - Z D Kobalava
- People's Friendship University of Russia (RUDN University)
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