Advanced Quantitative Echocardiography: Guiding Therapy for Heart Failure

textabstractThe aim of this thesis was to investigate the potential application of echocardiography for an efficient management of heart failure (HF) patients. The thesis is presented in four parts as follows: part I (introduction), part II (assessment of global left ventricular systolic function), part III (assessment of cardiac resynchronization therapy), and part IV (summary and conclusion). The general introduction (Chapter 1) of this thesis provides an overview of HF management using cardiac resynchronization therapy (CRT). HF constitutes an increasing and prevalent health burden worldwide. Echocardiography is a versatile non-invasive imaging modality that can be used for an efficient management of HF by proper diagnosis and guiding therapeutic interventions. Accurate assessment of left ventricular (LV) volumes and ejection fraction (LV-EF) would have important prognostic implications. CRT is a technique in which atrio-biventricular pacing is used to improve clinical and echocardiographic outcome for selected HF patients. The rationale behind CRT is the restoration of atrio-ventricular, inter-ventricular and intra-ventricular synchrony by stimulation of the delayed ventricular sites. It results in effective LV filling and emptying, reducing ventricular size improving ventricular geometry and most importantly improves survival. However, these impressive results of CRT are not seen in ~30% of patients. There are several unresolved and potentially other undetected reasons behind the high percentage of CRT failure. The echocardiography may improve the efficacy of CRT by reducing the non –response rate. The potential fields of echocardiography are: proper selection of candidates; optimization of atrio- and inter-ventricular pacing; guiding lead placement and proper detection of the response to CRT by accurate assessment of atrial and ventricular structure and function. These fields are mostly the topics of this thesis