Echocardiographic characterization of heart failure

Heart failure is a highly prevalent disease. In failure, the pump function of the heart is insufficient, leading to symptoms such as shortness of breath and fluid retention. Echocardiography is commonly used to diagnose heart failure. Echocardiography can be used to determine the ejection fraction. Every beat, the heart is filled with blood. The percentage of blood that gets ejected every beat is called the ejection fraction. Ejection fraction is around 60% in healthy people. From literature, we know that patients with an ejection fraction below 40% will benefit from medical therapy, and sometimes device therapy of the heart.

However, some patients with symptoms of heart failure have an ejection fraction above 40%. So far, no treatments have been shown effective in this group of patients. The aims of this thesis were to further characterize patients with an ejection fraction above 40%, especially those with a ‘mildly reduced’ or ‘mid-range’ ejection fraction of 40-50%. In addition, we examined the value of additional echocardiographic parameters for the diagnosis of heart failure.

We found that evidence is starting to accumulate that patients with a mildly reduced ejection fraction benefit from medical therapy as well. Even after comprehensive echocardiographic examination, the diagnosis of heart failure with a preserved ejection fraction often remains uncertain. Finally, we found that in patients with a reduced ejection fraction, those with dilated left ventricles seem to benefit most from medical therapy.