In outpatients with new-onset HF examined with TTE, including conventional Doppler and TDI, LA strain rate is significantly reduced in both HFrEF and HFpEF groups (without differences between them) compared with the non-HF group, with LA strain rate and indexed volume showing significant accuracy for HF diagnosis in receiver operating characteristic curves; however, LV strain rate shows no differences between non-HF and HFpEF groups, while both differed from the HFrEF group [64]. In patients with suddenly decompensated HF and presenting to the ED, point-of-care TTE has diagnostic sensitivity of 74% and specificity of 74% for HFrEF, changing to 36% and 100%, respectively, when combined with inferior vena cava collapsibility index and pleural sampling for B-lines; sensitivity and specificity of NT- proBNP >500 are 75% and 83%, respectively [65]. With the determination of HFrEF using TTE, LV filling pressure can be estimated well by LA expansion index, which predicts subsequent adverse events [66]. While early mitral inflow velocity to early diastolic mitral annular velocity on TTE with TDI is significantly higher in the elderly, compared to nonelderly, patients presenting with newly diagnosed suddenly decompensated HFrEF, there are no significant differences in in-hospital mortality, rehospitalization, and cardiovascular mortality during the following 45 months [53]. However, right ventricular (RV) systolic dysfunction, assessed using TTE with TDI of peak systolic velocity at the lateral tricuspid annulus, has prognostic significance in newly diagnosed HFrEF patients [67]. Diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF. It is implicated as a major cause of shortness of breath on exertion in elderly primary-care patients who often are suffering from unrecognized HF (16%), more often from HFpEF (12%) than from either HFrEF (3%) or isolated right-sided HF (1%) as determined on TTE evaluation [68].
Suspected New Onset and Known Nonacute Heart Failure. In outpatients with new-onset HF examined with TTE, including conventional Doppler and TDI, LA strain rate is significantly reduced in both HFrEF and HFpEF groups (without differences between them) compared with the non-HF group, with LA strain rate and indexed volume showing significant accuracy for HF diagnosis in receiver operating characteristic curves; however, LV strain rate shows no differences between non-HF and HFpEF groups, while both differed from the HFrEF group [64]. In patients with suddenly decompensated HF and presenting to the ED, point-of-care TTE has diagnostic sensitivity of 74% and specificity of 74% for HFrEF, changing to 36% and 100%, respectively, when combined with inferior vena cava collapsibility index and pleural sampling for B-lines; sensitivity and specificity of NT- proBNP >500 are 75% and 83%, respectively [65]. With the determination of HFrEF using TTE, LV filling pressure can be estimated well by LA expansion index, which predicts subsequent adverse events [66]. While early mitral inflow velocity to early diastolic mitral annular velocity on TTE with TDI is significantly higher in the elderly, compared to nonelderly, patients presenting with newly diagnosed suddenly decompensated HFrEF, there are no significant differences in in-hospital mortality, rehospitalization, and cardiovascular mortality during the following 45 months [53]. However, right ventricular (RV) systolic dysfunction, assessed using TTE with TDI of peak systolic velocity at the lateral tricuspid annulus, has prognostic significance in newly diagnosed HFrEF patients [67]. Diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF. It is implicated as a major cause of shortness of breath on exertion in elderly primary-care patients who often are suffering from unrecognized HF (16%), more often from HFpEF (12%) than from either HFrEF (3%) or isolated right-sided HF (1%) as determined on TTE evaluation [68].