Echocardiography in heart failure: Beyond diagnosis

It is a great honor for me to deliver this year's Euro Echo Lecture in this beautiful city of Florence and I appreciate the European Association of Echocardiography for the invitation and this opportunity to discuss the role of echocardiography in systolic and diastolic heart failure as the single most useful test, not only in diagnosis, but also as a tool to provide insights into the pathophysiological mechanism of various etiologies of heart failure, as a tool to monitor patient's response to various treatment options, and as a tool to help us develop innovative new therapies for heart failure.According to the ESC guidelines published in 2005, heart failure is defined as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood” which includes diastolic as well as systolic heart failure.1 ACC/AHA guidelines as well as ESC guidelines state that echocardiography is the single most useful test in the diagnosis of heart failure since structural abnormality, systolic dysfunction, diastolic dysfunction, or a combination of these abnormalities needs to be documented in patients who present with resting or/and exertional symptoms of heart failure to establish a definitive diagnosis of heart failure.1,2 It is important to demonstrate an objective evidence of structural or functional abnormalities to explain patient's symptoms of heart failure since symptoms of heart failure are not specific and more than a third of patients with a clinical diagnosis of heart failure may not actually have heart failure. It is also interesting to note from the SHAPE study that only 3% of more than 7000 subjects surveyed from nine European countries recognized breathlessness, fatigue, and edema as symptoms of heart failure.3 Moreover, even when someone presents with typical symptoms of heart …