Echocardiography is uniquely suited to characterize anatomical and functional abnormalities in patients at risk of developing heart failure, suspected of having heart failure, and with symptomatic heart failure. Furthermore, echocardiography can provide prognostic information and assist in the management of patients with acute, chronic and end-stage HF.

Evaluation of Cause of HF by Echocardiography
By assessing cardiac structure and function echocardiography plays a central role in determining the etiology of HF. An echocardiogram demonstrating a dilated left ventricle (LV) with decreased global systolic function and no significant valvular abnormalities will suggest the presence of a dilated cardiomyopathy. Similar findings with associated segmental LV wall motion abnormalities will suggest ischemic cardiomyopathy. A dilated LV with impaired systolic function and associated severe mitral or aortic insufficiency would suggest the presence of HF secondary to valvular heart disease. And a HF patient with a non-dilated, hypertrophied LV with preserved systolic function will most likely have either hypertensive heart disease Hypertrophic cardiomyopathy or an infiltrative cardiomyopathy (see Figure 1).

Figure 1: 3-D Echocardiograms with Apical Four-chamber View Equivalents Demonstrating a Globally Dilated Left Ventricle in a Patient with Dilated Cardiomyopathy

(A), to be contrasted wit a patient with ischemic cardiomyopathy and an apical aneurysm (B).

Characterization of Functional Abnormalities by Echocardiography HF in Patients with Systolic Dysfunction
M-mode echocardiographic measerements of LV function benefit from high temporal resolution, but are inaccurate in patients with segmental dysfunction or non-elliptical ventricles. Qualitative, ‘eyeball’ grading of left ventricular systolic dysfunction into mild, moderate or severe categories is widely used in clinical practice, but requires careful standardization and is difficult to obtain.

Quantitative two-dimensional (2-D) visual assessment has been shown to detect depressed LV ejection fraction with good sensitivity and specificity, but this procedure is only reliable with experienced observers. The apical biplane modified Simpson method of discs has also been validated, but requires accurate endocardial definition, and inclusion of the true LV apex on the imaging planes. Left-sided contrast agents can facilitate endocardial visualization and improve volumetric estimations and reproducibility.