Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography.

Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or clinical concerns for heart failure. Given the presence of diastolic dysfunction in many cardiovascular diseases, clinical reports should include comments on diastolic function and/or left atrial (LA) pressure whenever possible. Since the publication of the 2016 ASE/EACVI guidelines for assessment of LV diastolic function, new data on additional echocardiographic variables as left atrial strain and their association with LV filling pressures have emerged.

New Algorithm for Estimating Left Ventricular Filling Pressure by Echocardiography.

Background: Evaluation of whether dyspnea has a cardiac cause is essential. Guidelines from 2016 were reported to result in a high incidence of indeterminate left ventricular (LV) filling pressure. We sought to validate a new algorithm for the estimation of LV filling pressure (LVFP) in a multicenter study, with the objective of decreasing the yield of indeterminate filling pressure and increasing accuracy.

Strain-based staging as a unifying concept in cardiac resynchronization therapy.

Aims: Left bundle branch block (LBBB) septal strain patterns are associated with left ventricular (LV) reverse remodelling after cardiac resynchronization therapy (CRT). However, their prognostic value and impact in patients undergoing CRT, as well as in CRT-eligible patients receiving conservative treatment, remains underexplored. This study aimed to validate the prognostic significance of LBBB strain patterns and elucidate the mechanisms underlying CRT response by evaluating their interaction with myocardial scar and clinical outcomes.

Noninvasive Pressure-Volume Analysis by Three-Dimensional Echocardiography: A Novel Powerful Method for Evaluating Left Ventricular Function.

Background: Pressure-volume (PV) analysis is the gold standard for evaluating left ventricular (LV) function but is rarely used clinically due to its invasiveness. We validated a noninvasive method for PV analysis by three-dimensional (3D) echocardiography against invasive reference measurements and a novel index of LV efficiency against LV efficiency derived from metabolism by positron emission tomography-computed tomography (PET-CT).

Methods: In 22 canines, LV volume was measured invasively using piezoelectric crystals and LV pressure by micromanometer.

Peak myocardial work assessment to detect coronary ischemia during dobutamine stress echocardiography.

Introduction: Peak global myocardial work efficiency (GWE), a measure of peak global myocardial constructive to wasted work ratio, has been shown to discriminate coronary ischemia during treadmill stress echocardiography (SE). We wanted to assess additive utility of peak global longitudinal strain (GLS), global work index (GWI), and GWE in improving positive predictive value (PPV) of an abnormal dobutamine stress echocardiography (DSE) and calculate cost-savings by avoiding secondary tests.

Methods: We prospectively enrolled patients with abnormal DSE who underwent secondary confirmatory tests to confirm significant CAD as our primary cohort, and measured baseline and peak GLS, GWI, and GWE.

Imaging-based method to quantify left ventricular diastolic pressures.

Aims: To establish an imaging-based method to quantify left ventricular (LV) diastolic pressures.

Methods And Results: In 115 patients suspected of coronary artery disease, LV pressure was measured by micromanometers and images by echocardiography. LV filling pressure was measured as LV pre-atrial contraction pressure (pre-A PLV).

Mechanism and Impact of Left Atrial Dyssynchrony on Long-Term Clinical Outcome During Cardiac Resynchronization Therapy.

Background: Left bundle branch block (LBBB) causes left atrial (LA) dyssynchrony. It is unknown if LA dyssynchrony impacts long-term prognosis.

Objectives: The purpose of this study was to determine mechanisms of LA dyssynchrony in LBBB and if LA dyssynchrony impacts long-term prognosis.

A deep learning based method for left ventricular strain measurements: repeatability and accuracy compared to experienced echocardiographers.

Background: Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values.

Myocardial Strain Imaging: Theory, Current Practice, and the Future.

Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter.

Left ventricular diastolic dysfunction in non-myocardial disorders.

This article reviews and discusses non-myocardial disorders that represent diagnostic challenges when evaluating patients for suspected heart failure with preserved left ventricular ejection fraction. This includes pre-capillary pulmonary hypertension, which is important to differentiate from post-capillary hypertension caused by left-sided heart disease. The impact of electrical disorders on LV diastolic function is also reviewed, and includes a discussion of left bundle branch, which has both a direct effect on LV diastolic function, as well as a long-term effect due to remodelling.

Left atrium as key player and essential biomarker in heart failure.

This article reviews roles of the left atrium as regulator of left ventricular filling, as compensatory reserve in left ventricular dysfunction and as diagnostic marker in patients with cardiovascular disorders. Application of novel imaging tools to assess left atrial function and their integration with conventional clinical methods are discussed. This includes a review of clinical applications of left atrial strain as a method to quantify the reservoir and booster pump components of left atrial function.

Mechanical dyssynchrony as a selection criterion for cardiac resynchronization therapy: Design of the AMEND-CRT trial.

Aims: One third of patients do not improve after cardiac resynchronization therapy (CRT). Septal flash (SF) and apical rocking (ApRock) are deformation patterns observed on echocardiography in most patients eligible for CRT. These markers of mechanical dyssynchrony have been associated to improved outcome after CRT in observational studies and may be useful to better select patients.

Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation.

Background: Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation.

Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony.

: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. : In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) ( = 127) and septal flash visually from cine CMR sequences.