Echocardiographic diagnosis of heart failure : From evaluation of left ventricular diastolic function to point-of-care ultrasonography
Focused cardiac ultrasound
The number of patients with heart failure is steadily increasing in Japan, and this situation is called the “heart failure pandemic”. Nowadays, echocardiography plays a center role in diagnosis of heart failure. It gives not only a definitive diagnosis of heart failure, but can also be used to determine its pathophysiology and the effect of treatment. Echocardiography can evaluate not only the morphology of the heart but also its function. The hemodynamic diagnosis of heart failure is made by demonstrating １） increased preload, ２） elevated left atrial pressure, and ３） decreased cardiac output. This article describes how to evaluate each of these including evaluation of left ventricular diastolic dysfunction. We also explain the clinical significance of preload stress echocardiography, which we are developing, in patients with heart failure. Although such echocardiographic diagnostic method is useful for understanding the condition of patients, it has become complicated, and it is difficult to make an accurate diagnosis unless a specialist in echocardiography. Recently, a new way of using ultrasound called “point-of-care ultrasonography（POCUS）” has been developed. This is an ultrasonography in which a physician who is not a specialist in ultrasonography can obtain information to be used as part of a physical examination and make on-site decisions. A diagnostic method for heart failure using POCUS is also described in this paper. In order to properly deal with heart failure, accurate evaluation of the pathology and selection of appropriate treatment, as well as picking up high-risk patients and initiating treatment early to prevent heart failure are essential. We would like to make widespread use of these echocardiographic techniques, which are useful for both understanding the pathology and determining the risk of heart failure, so that more patients can benefit.
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