Key result
Multimodal multiparameter assessment improves HF risk prediction over LVEF alone.
Why the study?
Left ventricular ejection fraction has important limitations as a measure of cardiac function and risk prediction in heart failure, especially near normal values, necessitating a more comprehensive assessment approach.
Does an integrative approach for assessment of cardiac structure and function improve risk prediction in patients with heart failure compared to LVEF alone?
Does an integrative approach for assessment of cardiac structure and function improve risk prediction in patients with heart failure compared to LVEF alone?
An integrative approach combining multiple imaging and clinical parameters may provide better risk stratification in heart failure than relying solely on LVEF.
Answers are grounded in this paper and cite their sources.
May enhance HF risk stratification beyond LVEF; leaves open prospective validation before practice change.
Left ventricular ejection fraction (LVEF) has been the central parameter used for diagnosis and management in patients with heart failure. A good predictor of adverse outcomes in heart failure when below ∼45%, LVEF is less useful as a marker of risk as it approaches normal. As a measure of cardiac function, ejection fraction has several important limitations. Calculated as the stroke volume divided by end-diastolic volume, the estimation of ejection fraction is generally based on geometric assumptions that allow for assessment of volumes based on linear or two-dimensional measurements. Left ventricular ejection fraction is both preload- and afterload-dependent, can change substantially based on loading conditions, is only moderately reproducible, and represents only a single measure of risk in patients with heart failure. Moreover, the relationship between ejection fraction and risk in patients with heart failure is modified by factors such as hypertension, diabetes, and renal function. A more complete evaluation and understanding of left ventricular function in patients with heart failure requires a more comprehensive assessment: we conceptualize an integrative approach that incorporates measures of left and right ventricular function, left ventricular geometry, left atrial size, and valvular function, as well as non-imaging factors (such as clinical parameters and biomarkers), providing a comprehensive and accurate prediction of risk in heart failure.
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Čikeš et al. (2015) conducted a review in heart failure. Integrative approach for cardiac assessment vs. Left ventricular ejection fraction (LVEF) alone was evaluated. An integrative approach incorporating multiple cardiac structural, functional, and non-imaging parameters provides a more comprehensive and accurate prediction of risk in heart failure than LVEF alone.
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