Should All Heart Failure Patients Undergo Echocardiographic Examination?

The recent advances in the management of chronic heart failure (CHF) have the potentials to delay the onset or slow down its progression, improve symptoms and quality of life with better clinical outcome. Early detection of CHF is very crucial for effective intervention but the diagnosis of mild cases is known to be difficult as there may be few clinical features at this stage. Although, some societies’ guidelines require both symptoms and objective evidence of cardiac dysfunction for diagnosis, the role of echocardiography in the assessment of CHF in the presence of overt symptoms has been controversial. The concern bothers mainly on the cost-effectiveness of the procedure and whether or not it adds value to patient care. A test useful to a patient is one that leads to better understanding and choice of treatment associated with improved clinical outcome. Echocardiography provides a rapid, non-invasive assessment of cardiac function which is relatively cheaper compared with competing technologies. It often provides morphologic and hemodynamic information which may guide the management of patients with CHF. Brain natriuretic peptide (BNP) is useful for screening for heart failure due to systolic dysfunction but it is not a substitute for echocardiography in the diagnosis of heart failure. We suggest that all patients with CHF should have echocardiographic examination (if possible) for adequate diagnosis and accurate risk quantification. This is crucial for drug choice and monitoring of therapy.