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STATE-OF-THE-ART PAPER

Echocardiography in Heart Failure

Applications, Utility, and New Horizons

James N. Kirkpatrick, MD^_*,_*, Mani A. Vannan, MBBS, FACC^,1, Jagat Narula, MBBS, PhD, FACC, FAHA^,2 and Roberto M. Lang, MD, FACC, FAHA, FESC, FASE^,3

^_* Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
University of California–Irvine, Orange, California
University of Chicago Hospitals, Chicago, Illinois.

Manuscript received January 16, 2007; revised manuscript received March 27, 2007, accepted March 29, 2007.

^_* Reprint requests and correspondence: Dr. James N. Kirkpatrick, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. (Email: James.Kirkpatrick{at}uphs.upenn.edu).

Echocardiography is well qualified to meet the growing need for noninvasive imaging in the expanding heart failure (HF) population. The recently-released American College of Cardiology/American Heart Association guidelines for the diagnosis and management of HF labeled echocardiography "the single most useful diagnostic test in the evaluation of patients with HF...," because of its ability to accurately and noninvasively provide measures of ventricular function and assess causes of structural heart disease. It can also detect and define the hemodynamic and morphologic changes in HF over time and might be equivalent to invasive measures in guiding therapy. In this article we will discuss: 1) the clinical uses of echocardiography in HF and their prognostic value; 2) the use of echocardiography to guide treatment in HF patients; and 3) promising future techniques for echocardiographic-based imaging in HF. In addition, we will highlight some of the limitations of echocardiography.

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   EF = ejection fraction   HF = heart failure   ICD = implantable cardioverter-defibrillator   LV = left ventricle/ventricular   LVEDP = left ventricular end-diastolic pressure   LVOT = left ventricular outflow tract   TDI = tissue Doppler imaging   SF = systolic fraction of pulmonary venous forward flow   VAD = ventricular assist device   Vp = flow propagation slope of early diastolic left ventricular filling

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