In dyspneic patients presenting to an ED, a basic bedside TTE diastolic evaluation performed by an emergency physician-sonographer with limited diastology-specific training (3 hours of didactic and hands-on training by a cardiologist) can accurately identify clinically significant diastolic dysfunction, although correct grading of dysfunction may be only moderately accurate [69]. Several TTE parameters, including ratio of early mitral inflow velocity to TDI velocity at lateral mitral annulus, LA volume index, and the difference between duration of reversed pulmonary vein LA systole flow and duration of mitral A wave flow, have the greatest value in diagnosing HFpEF (sensitivity of 77% and specificity of 81%) [70]. However, for the initial diagnosis of HFpEF, the association of NT-proBNP measurement and TTE with TDI is superior to the use of either one alone [61]. Certainly, echocardiography technologies have provided greater understanding of the complex pathophysiology related to HFpEF. From the application of TTE with speckle tracking [71], it is now known that HFpEF patients (1) demonstrate significantly lower longitudinal and circumferential strains compared to both normal patients and hypertensive heart disease patients, indicating the presence of underlying impaired LV systolic function [72]; (2) have significantly lower myocardial systolic and diastolic LV performance compared to patients with asymptomatic LV diastolic dysfunction, and this combined dysfunction is associated with increased LV filling Suspected New-Onset and Known Nonacute Heart Failure
Suspected New Onset and Known Nonacute Heart Failure. In dyspneic patients presenting to an ED, a basic bedside TTE diastolic evaluation performed by an emergency physician-sonographer with limited diastology-specific training (3 hours of didactic and hands-on training by a cardiologist) can accurately identify clinically significant diastolic dysfunction, although correct grading of dysfunction may be only moderately accurate [69]. Several TTE parameters, including ratio of early mitral inflow velocity to TDI velocity at lateral mitral annulus, LA volume index, and the difference between duration of reversed pulmonary vein LA systole flow and duration of mitral A wave flow, have the greatest value in diagnosing HFpEF (sensitivity of 77% and specificity of 81%) [70]. However, for the initial diagnosis of HFpEF, the association of NT-proBNP measurement and TTE with TDI is superior to the use of either one alone [61]. Certainly, echocardiography technologies have provided greater understanding of the complex pathophysiology related to HFpEF. From the application of TTE with speckle tracking [71], it is now known that HFpEF patients (1) demonstrate significantly lower longitudinal and circumferential strains compared to both normal patients and hypertensive heart disease patients, indicating the presence of underlying impaired LV systolic function [72]; (2) have significantly lower myocardial systolic and diastolic LV performance compared to patients with asymptomatic LV diastolic dysfunction, and this combined dysfunction is associated with increased LV filling Suspected New-Onset and Known Nonacute Heart Failure