Is there the phenotype of chronic heart failure with “intermediate” left ventricular ejection fraction? Additional echocardiographic criteria for left ventricular systolic dysfunction in patients with chronic heart failure of ischemic origin with ejection fraction in the “gray area”
DOI:
https://doi.org/10.14739/2310-1210.2021.3.224710Keywords:
heart failure, ventricular ejection fraction, cardiac remodeling, systoleAbstract
Patients with chronic heart failure (CHF) with left ventricular ejection fraction (LV EF) in the range of 40–55 % form a separate group with “intermediate” or “moderately reduced” LV EF. Since there are a number of additional criteria in echocardiography other than EF for determining LV systolic function (TEI, MAPSE, systolic velocity of the fibrous ring of the mitral valve (S’), E/e’, dP/dt mitral regurgitation, etc.), their use may be helpful in the final identification of systolic dysfunction in CHF patients with LV EF within the “gray area”.
The aim of the work – to find out the possibility of using ultrasound parameters of LV systolic function as additional diagnostic criteria for systolic dysfunction and to develop an algorithm for its diagnosis in CHF patients with LV EF within the “gray zone” (40–55 %).
Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with LV EF from 40 % to 55 % (main group) who were divided into two subgroups: the first subgroup (n = 40) – patients with LV EF within the “gray area 45–55 %”, the second subgroup (n = 39) – patients with LV EF less than 45 %. The comparison group – 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy).
Results. According to our results, 90 % (71/79) of CHF patients with reduced LV EF had mitral regurgitation. Additional examination of the systolic index dP/dT of less than 1200 mm Hg/s on the flow of mitral regurgitation allowed to classify CHF patients from the “gray area” (LV EF 40–55 %) to the CHF phenotype with reduced LV EF, and that was almost half of patients – 50.6 % (40/79). Cut off points were established for Myocardial Performance Index TEI of the LV >0.56 r. u., the right ventricle >0.51 r. u., decrease in systolic dP/dT ≤1000 mm Hg/s, systolic velocity of the medial (S med ≤7 cm/s) and the lateral (S lat ≤7 cm/s) fibrous ring of the mitral valve, the amplitude of the medial (MAPSE med ≤11.7 mm) and the lateral (MAPSE lat ≤11.1 mm) fibrous ring of the mitral valve.
Conclusions. The cohort of CHF patients with “intermediate” LV EF is a heterogeneous group, which includes patients according to one formal criterion – LV EF in the range of 40–55 %. LV EF is a surrogate marker, insufficient for the final determination of the CHF phenotype. Additional criteria for systolic dysfunction include ventricular TEI, dP/dT mitral regurgitation, systolic velocity (S), and amplitude (MAPSE) of the medial and lateral fibrous ring of the mitral valve. In the presence of two or more additional ultrasound criteria for systolic LV dysfunction, CHF patients with LV EF within 40–55 % should be considered as patients with reduced LV EF.
References
Luis, S. A., Chan, J., & Pellikka, P. A. (2019). Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography. Mayo Clinic Proceedings, 94(1), 125-138. https://doi.org/10.1016/j.mayocp.2018.07.017
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J., Coats, A., Falk, V., González-Juanatey, J. R., Harjola, V. P., Jankowska, E. A., Jessup, M., Linde, C., Nihoyannopoulos, P., Parissis, J. T., Pieske, B., Riley, J. P., Rosano, G., Ruilope, L. M., Ruschitzka, F., Rutten, F. H., … ESC Scientific Document Group. (2016). 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. European Heart Journal, 37(27), 2129-2200. https://doi.org/10.1093/eurheartj/ehw128
Butler, J., Fonarow, G. C., Zile, M. R., Lam, C. S., Roessig, L., Schelbert, E. B., Shah, S. J., Ahmed, A., Bonow, R. O., Cleland, J. G., Cody, R. J., Chioncel, O., Collins, S. P., Dunnmon, P., Filippatos, G., Lefkowitz, M. P., Marti, C. N., McMurray, J. J., Misselwitz, F., Nodari, S., … Gheorghiade, M. (2014). Developing Therapies for Heart Failure With Preserved Ejection Fraction: Current State and Future Directions. JACC: Heart Failure, 2(2), 97-112. https://doi.org/10.1016/j.jchf.2013.10.006
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Jr, Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., Johnson, M. R., Kasper, E. K., Levy, W. C., Masoudi, F. A., McBride, P. E., McMurray, J. J., Mitchell, J. E., Peterson, P. N., Riegel, B., Sam, F., … Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 128(16), 1810-1852. https://doi.org/10.1161/CIR.0b013e31829e8807
Cikes, M., & Solomon, S. D. (2016). Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. European Heart Journal, 37(21), 1642-1650. https://doi.org/10.1093/eurheartj/ehv510
Voronkov, L. H., Amosova, K. M., Dziak, H. V., Zharinov, O. Y., Kovalenko, V. M., Korkushko, O. V., Nesukai, O. H., Sychov, O. S., Rudyk, Yu. S., & Parkhomenko, O. M. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti (2017) [Guidelines of the Ukrainian Association of Cardiology for the Diagnosis and Treatment of Chronic Heart Failure (2017)]. Sertseva nedostatnist ta komorbidni stany, (1, dodatok 1), 1-66. [in Ukranian].
WRITING COMMITTEE MEMBERS, Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Jr., Colvin, M. M., Drazner, M. H., Filippatos, G., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2016). 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 134(13), e282-e293. https://doi.org/10.1161/CIR.0000000000000435
Tei, C., & Otsuji, Y. (2008). Chapter 16 - Evaluation of Tei Index in Heart Failure. In A. L. Klein & M. J. Garcia (Eds.), Diastology (pp. 193-201). Saunders. https://doi.org/10.1016/b978-1-4160-3754-5.50022-6
Kadappu, K. K., & Thomas, L. (2015). Tissue Doppler Imaging in Echocardiography: Value and Limitations. Heart, Lung & Circulation, 24(3), 224-233. https://doi.org/10.1016/j.hlc.2014.10.003
Nagueh, S. F., Appleton, C. P., Gillebert, T. C., Marino, P. N., Oh, J. K., Smiseth, O. A., Waggoner, A. D., Flachskampf, F. A., Pellikka, P. A., & Evangelisa, A. (2009). Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. European Journal of Echocardiography, 10(2), 165-193. https://doi.org/10.1093/ejechocard/jep007
Simpson, T. F., Tyler, J. M., Thomas, R. C., Fang, Q., Bibby, D., & Schiller, N. B. (2019). Mitral annular peak systolic and diastolic velocities are characteristic of healthy hearts: A Doppler tissue imaging study. Echocardiography, 36(3), 433-438. https://doi.org/10.1111/echo.14247
Hu, K., Liu, D., Herrmann, S., Niemann, M., Gaudron, P. D., Voelker, W., Ertl, G., Bijnens, B., & Weidemann, F. (2013). Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease. European Heart Journal - Cardiovascular Imaging, 14(3), 205-212. https://doi.org/10.1093/ehjci/jes240
Wenzelburger, F. W., Tan, Y. T., Choudhary, F. J., Lee, E. S., Leyva, F., & Sanderson, J. E. (2011). Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction. European Journal of Heart Failure, 13(9), 953-960. https://doi.org/10.1093/eurjhf/hfr081
Fomenko, E. V. (2019). Osobennosti ul'trazvukovogo issledovaniya tsentral'noi gemodinamiki u lits s displaziei soedinitel'noi tkani. Dis. … kand. med. nauk. [Features of ultrasound examination of central hemodynamics in persons with connective tissue dysplasia. Dr. med. sci. diss.]. Moscow. [in Russian].
Fang, Z. Y., Schull-Meade, R., Leano, R., Mottram, P. M., Prins, J. B., & Marwick, T. H. (2005). Screening for heart disease in diabetic subjects. American Heart Journal, 149(2), 349-354. https://doi.org/10.1016/j.ahj.2004.06.021
Rangarajan, V., Chacko, S. J., Romano, S., Jue, J., Jariwala, N., Chung, J., & Farzaneh-Far, A. (2016). Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events. Journal of Cardiovascular Magnetic Resonance, 18(1), Article 35. https://doi.org/10.1186/s12968-016-0257-y
Katsanos, A. H., Spence, J. D., Bogiatzi, C., Parissis, J., Giannopoulos, S., Frogoudaki, A., Safouris, A., Voumvourakis, K., & Tsivgoulis, G. (2014). Recurrent Stroke and Patent Foramen Ovale: A Systematic Review and Meta-Analysis. Stroke, 45(11), 3352-3359. https://doi.org/10.1161/STROKEAHA.114.007109
Goroshi, M., & Chand, D. (2016). Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian Heart Journal, 68(1), 83-87. https://doi.org/10.1016/j.ihj.2015.06.022
Sokolov, A. A., Martsinkevich, G. I., & Smorgon, A. V. (2019). Diagnosticheskoe znachenie ekhokardiograficheskogo miokardial'nogo indeksa TEI v otsenke narushenii nasosnoi i kontraktil'noi funktsii levogo zheludochka, vozrastnye i nozologicheskie aspekty [The diagnostic value of the echocardiographic myocardial index of TEI in the estimation of disorders of the pump and contractile functions of the left ventricle]. Sibirskii zhurnal klinicheskoi i eksperimental'noi meditsiny, 34(1), 61-68. https://doi.org/10.29001/2073-8552-2019-34-1-61-68 [in Russian].
Hashemi, N., Samad, B. A., Hedman, A., Brodin, L. Å., & Alam, M. (2014). Feasibility of Myocardial Performance Index for Evaluation of Left Ventricular Function during Dobutamine Stress Echocardiography before and after Coronary Artery Bypass Grafting. Echocardiography, 31(8), 989-995. https://doi.org/10.1111/echo.12488
Fomenko, E. V., Beresten, N. F., Tkachenko, S. B., Kolesnikov, V. N., & Romanov, S. N. (2018). Indeks Teі - rannii marker diastolicheskoi disfunktsii LZh u lits s kardial'nymi proyavleniyami displazii soedinitel'noi tkani [Index Tei an early marker of left ventricular diastolic dysfunction in persons with cardiac manifestations of connective tissue dysplasia]. Meditsinskii alfavit, 4(36), 42-48. [in Russian].
Sanchez Mejia, A. A., Simpson, K. E., Hildebolt, C. F., Pahl, E., Matthews, K. L., Rainey, C. A., Canter, C. E., Jay, P. Y., & Johnson, M. C. (2014). Tissue Doppler Septal Tei Index Indicates Severity of Illness in Pediatric Patients With Congestive Heart Failure. Pediatric Cardiology, 35(3), 411-418. https://doi.org/10.1007/s00246-013-0794-1
Bruch, C., Schmermund, A., Dagres, N., Katz, M., Bartel, T., & Erbel, R. (2002). Tei-index in symptomatic patients with primary and secondary mitral regurgitation. The International Journal of Cardiovascular Imaging, 18(2), 101-110. https://doi.org/10.1023/a:1014664418322
Baykan, M., Erem, C., Gedikli, O., Hacihasanoglu, A., Erdogan, T., Kocak, M., Kaplan, S., Kiriş, A., Orem, C., & Celik, S. (2008). Assessment of Left Ventricular Diastolic Function and Tei Index by Tissue Doppler Imaging in Patients with Cushing's Syndrome. Echocardiography, 25(2), 182-190. https://doi.org/10.1111/j.1540-8175.2007.00572.x
Hilde, J. M., Skjørten, I., Grøtta, O. J., Hansteen, V., Melsom, M. N., Hisdal, J., Humerfelt, S., & Steine, K. (2013). Right Ventricular Dysfunction and Remodeling in Chronic Obstructive Pulmonary Disease Without Pulmonary Hypertension. Journal of the American College of Cardiology, 62(12), 1103-1111. https://doi.org/10.1016/j.jacc.2013.04.091
Bhat, P. K., Khan, I., Finkelhor, R. S., Bahler, R. C., & Rovner, A. L. (2014). Right Ventricular Myocardial Performance Index Derived from Tissue Doppler Echocardiography Is Useful in Differentiating Apical Ballooning Syndrome from Cardiomyopathy Due to Left Anterior Descending Coronary Artery Disease. Journal of the American Society of Echocardiography, 27(1), 101-106. https://doi.org/10.1016/j.echo.2013.09.001
Poteshkina, N. G., Demkina, А. Е., & Krylova, N. S., & Kovalenskaya, Е. А., & Khashieva, F. М. (2016). Vklad disfunktsii pravogo zheludochka v kartinu khronicheskoi serdechnoi nedostatochnosti u patsientov s gipertroficheskoi kardiomiopatiei [Impact of the right ventricle dysfunction on chronic heart failure presentation in patients with hypertrophic cardiomyopathy]. Rossiiskii kardiologicheskii zhurnal, (8). 53-57. https://doi.org/10.15829/1560-4071-2016-8-53-57 [in Russian].
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
