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Background: Titration of evidence-based medications, important for treating heart failure (HF), is often underdosed by symptom-guided treatment. The aim of this study was to investigate, using echocardiographic parameters, stroke volume and left ventricular (LV) filling pressure to guide up-titration of medications, increasing prognostic benefits., Methods: A total of 765 patients with chronic HF and severely reduced LV ejection fractions (<35%), referred from 2008 to 2016, were prospectively studied. Echocardiographic guidance was performed in 149 patients. LV filling pressure was assessed by left atrial expansion index, and stroke volume was estimated from diameter and time-velocity integral in the LV outflow tract. Up-titration of evidence-based medications and adjustment for side effects or worsening clinical conditions according to those parameters were performed. Propensity score matching was used to match pairs of patients with (n = 110) or without (n = 110) echocardiographic guidance. End points were 4-year frequencies of HF hospitalization and all-cause mortality., Results: During a mean follow-up time of 4.1 years, rates of adverse events were 58 (52.7%) with no echocardiographic guidance and 36 (32.7%) with echocardiographic guidance (P < .0001). Echocardiography provided effective guidance to reduce prescribing frequency and dose of diuretics and to promote evidence-based medication prescription. It reduced HF rehospitalization and all-cause mortality. By multivariate analysis, prognostic improvement was associated with up-titration of medications with echocardiographic guidance., Conclusions: There was a statistically significant difference in long-term prognosis between propensity score-matched pairs of patients with chronic severe HF with and without echocardiographic guidance. These findings need further validation in large prospective clinical trials., (Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Although E/e' (the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity) is widely used to measure left ventricular filling pressure (LVFP), its accuracy is questionable in coronary artery disease patients., Methods and Results: Echocardiograms and LVFP were obtained from 174 patients with stable angina (Canadian Cardiovascular Society angina grade I-II) who had received interventions for angiography-confirmed coronary stenosis. Compared with single-vessel groups, the multiple-vessel group exhibited lower mitral annular velocities, higher LVFP, and stronger correlations between E/regional e' and LVFP. Additionally, stronger correlations between E/regional e' and LVFP existed in patients with systolic dysfunction or lower variation of myocardial performance index (MPI) among anterior, inferior and lateral borders of mitral annulus. Average e' was not superior to any regional e' for assessing LVFP by the E/e' method. E/e' and left atrial (LA) ejection fraction (EF) correlated linearly with LVFP, but the correlation between LA distensibility and LVFP was logarithmical. Compared with E/e', LA distensibility and LAEF were superior for identifying high LVFP., Conclusions: E/e' is not completely satisfactory for assessing LVFP in patients with stable angina, especially those with single-vessel disease, preserved systolic function or high MPI variation. For identifying high LVFP, LA distensibility and LAEF are better than E/e'.

Background: Evaluating right ventricular dysfunction, pulmonary artery systolic pressure (PASP), and exercise tolerance is critical in patients with systemic lupus erythematosus (SLE) because of the high mortality rate in such patients with pulmonary arterial hypertension (PAH). The aim of this study was to use the flow propagation velocity (FPV) of early diastolic tricuspid inflow to evaluate exercise tolerance and PAH severity and to predict readmission in patients with SLE., Methods: A total of 66 patients with SLE with or without PAH and 30 healthy control subjects were enrolled. Controls were age-matched to patients with SLE and without PAH. All patients completed the 6-minute walking distance (6MWD) test and underwent standard echocardiography. Tricuspid FPV was measured in the modified parasternal short-axis view using the color M-mode technique. PAH was defined as PASP > 35 mm Hg using the tricuspid regurgitant method., Results: Patients with SLE and PAH had significantly lower tricuspid FPVs and 6MWDs than patients in the other 2 groups (both P values < .001). Tricuspid FPV was well correlated with 6MWD (r = 0.748, P < .001). In multivariate analysis, right atrial pressure was the only independent factor affecting tricuspid FPV (R(2) = 0.394, P < .001), and 6MWD was affected only by tricuspid FPV and PASP (R(2) = 0.629, P < .001). Patients with SLE who had been readmitted had lower tricuspid FPVs than those who had not (P = .035). Furthermore, FPV > or = 35.4 cm/s predicted 6MWD > or = 350 m and a lower 1-year readmission rate with good sensitivity and specificity., Conclusion: The tricuspid FPV technique provides a simple method for predicting exercise tolerance, the severity of PAH, and readmission among patients with SLE.

The present study was undertaken to determine the sensitivity and specificity of echocardiography in the diagnosis of pulmonary embolism (PE). The study consisted of 2 stages. First, 600 patients were enrolled to measure bilateral pulmonary blood flow by echocardiography. Using multidetector row computed tomography, 200 subjects were diagnosed with pulmonary hypertension and 100 with defined PE. Another 300 subjects without cardiopulmonary distress served as controls. The time-velocity integral (TVI) and flow volume of both pulmonary arteries were obtained. The percentage differences in bilateral pulmonary arterial TVI (DeltaTVI/mean) were 12.0 +/- 9.3%, 13.8 +/- 12.1%, and 38.6 +/- 14.9% for controls, subjects with pulmonary hypertension, and subjects with PE, respectively. The percentage differences in bilateral pulmonary flow (Deltaflow/mean) were 15.1 +/- 11.7%, 17.6 +/- 14.9%, and 36.8 +/- 17.5% for controls, subjects with pulmonary hypertension, and subjects with PE, respectively. By receiver-operating characteristic curve analysis, the cut-off points for DeltaTVI/mean and Deltaflow/mean to identify PE were 25% and 26.5%, respectively. In the second part of study, the accuracy of DeltaTVI/mean and Deltaflow/mean to screen 300 patients with suspected PE was tested. Echocardiography provided high degrees of sensitivity and specificity for the diagnosis of PE. In conclusion, bilateral pulmonary arterial flow measurement is a simple and useful test to assess the possibility of PE.

Objectives: The aim of this study was to investigate the changes of flow propagation velocity (FPV) after regular hemodialysis (H/D) in patient who were uremic with different baseline left ventricular (LV) functions., Methods: In all, 24 patients with uremia and abnormal LV systolic function were enrolled in this study and 30 patients with uremia and normal LV systolic performance served as the control group. All patients had in sinus rhythm and underwent a comprehensive transthoracic echocardiographic examination and mitral FPV by color M-mode echocardiography before and after H/D., Results: The decline in FPV before H/D was proportional to the decline in the baseline LV function, whereas FPV after H/D varied according to the LV ejection fraction. An obvious decrement of FPV for patients with normal LV systolic function was noted, but no obvious difference was seen for patients with abnormal LV systolic function., Conclusion: FPV was strongly preload dependent for patients with normal LV systolic function. It was not significantly influenced by preload for patients with abnormal LV systolic function. FPV is a relatively good diastolic parameter for investigating patients with LV systolic dysfunction.

Because left atrial (LA) volume plays a critical role in determining cardiovascular outcomes, it was hypothesized that this might be related to the distensibility of the left atrium and how this relates to left ventricular filling pressure (LVFP). Echocardiographic estimates of LVFP were compared to cardiac catheterization measurements in 521 consecutive patients with acute myocardial infarction and correlated with short- and long-term outcomes. Receiver-operating characteristic curve analysis was performed to investigate the sensitivity and specificity of echocardiographic parameters for predicting elevated LVFP (>15 mm Hg). LA distensibility was calculated as (maximal volume − minimal volume) × 100%/minimal volume. and was found to be logarithmically associated with LVFP (p <0.0001). LA distensibility was superior to mitral E/annular Em for identifying increased LVFP (area under the receiver-operating characteristic curve 0.92 vs 0.78). A total of 44 patients died during hospitalization, and 89 patients had died or experienced heart failure requiring rehospitalization at 12-month follow-up. In a multivariate Cox regression model, LA distensibility was an independent predictor of in-hospital mortality (hazard ratio 2.373 for LA distensibility ≤60%, p = 0.026), while LA volume was an independent prognostic factor of 1-year death or heart failure (hazard ratio 2.266 for LA volume ≥34 ml/m2, p = 0.007). In conclusion, LA distensibility accurately identifies patients with increased LVFP after acute myocardial infarction and is an independent predictor of in-hospital mortality. [ABSTRACT FROM AUTHOR]

Echocardiograms and left ventricular (LV) filling pressure were obtained from 95 patients with chronic severe mitral regurgitation (MR) and 16 patients with acute severe MR. All patients underwent catheterization for preoperative examinations and LV filling pressure measurements. A total of 52 age-, gender- and co-morbidity–matched patients with negative coronary angiographic results served as the controls. Echocardiography, including assessment of left atrial (LA) distensibility, was performed simultaneously. LA distensibility correlated logarithmically with the LV filling pressure. However, the early-diastolic mitral inflow velocity divided by the early-diastolic mitral annular velocity (mitral E/E′) correlated linearly with the LV filling pressure. Bivariate correlation analysis revealed that LV filling pressure correlated positively with the maximum and minimum indexed LA volume, as well as the E/E′, but the LV filling pressure correlated negatively with LA distensibility, LA ejection fraction, and LV ejection fraction. However, the MR regurgitation volume was associated only with the maximum and minimum indexed LA volume. Receiver operating characteristic curve analysis indicated that LA distensibility was not inferior to E/E′ for identifying a LV filling pressure >15 mm Hg. However, to identify acute severe MR, LA distensibility was superior to E/E′. In conclusion, LA distensibility, as is E/E′, is a valuable diastolic parameter. In patients with severe MR, it offers adequate power to assess the LV filling pressure and to identify acute severe MR. [Copyright &y& Elsevier]