BACKGROUND
Globally Heart failure (HF) is a prominent contributor to cardiovascular
morbidity and mortality worldwide. It is primarily diagnosed based on
the patient’s signs and symptoms, with laboratory investigations
traditionally not being integral to the diagnostic process, except for
brain natriuretic peptide. However, echocardiography has become
indispensable for evaluating and managing heart failure. It plays a
pivotal role in caring for HF patients, from initial phenotyping and
risk stratification to offering vital data for guiding therapeutic
decision-making and monitoring their progress.
The assessment of left ventricular ejection fraction (LVEF) is a
fundamental aspect of imaging studies, used to evaluate the left
ventricular systolic function and has been established as a strong
predictor of mortality among patients with heart failure and low LVEF.
LVEF is defined as the ratio of the blood ejected during systole (stroke
volume) to the blood remaining in the ventricle at the end of diastole
(end-diastolic volume). To measure LVEF, the American Society of
Echocardiography recommends using the biplane method of disks (modified
Simpson method), which is a 2D echocardiographic technique involving
area tracings of the left ventricular cavity.
The advent of two-dimensional speckle tracking echocardiography has
introduced a novel approach to evaluate left ventricular (LV) function
referred to as Global Longitudinal Strain (GLS). This method offers a
simple bedside modality for objective assessment of both global and
regional function of the left ventricle GLS and has proven to be a
valuable tool in predicting outcomes for patients with various cardiac
conditions, including heart failure, coronary artery disease, valvular
heart disease, and cardiomyopathies.
The tissue doppler early diastolic mitral annular velocity (e’) serves
as an indicator of left ventricular relaxation. To assess diastolic
function, the E/e’ ratio combines the early filling velocity measured
with trans mitral doppler (E) and the early relaxation velocity with
tissue doppler (e’). The ratio of trans mitral doppler early filling
velocity (E) to e’ (E/e’) is suggested as a valuable index for
estimating left atrial pressure and serves as a measure for left
ventricular end-diastolic pressure.
NT pro-BNP is released by cardiomyocytes in response to stretching and
undergoes rapid cleavage into biologically active B-type natriuretic
peptide, and the inert 76-amino acid NT pro-BNP. One notable disparity
between these two molecules lies in their stability, with NT pro-BNP
exhibiting significantly higher stability. Both of these fragments find
common usage in aiding the diagnosis of heart failure, predicting
patient outcomes, and monitoring the efficacy of therapeutic
intervention.
Studies have reported left atrial (LA) remodelling in patients with
heart failure and LA remodelling is linked to dysfunction in LA
appendage (LAA), and the LAA wall motion velocity (LAAWV) obtained
through transthoracic echocardiography can assess LAA dysfunction
non-invasively. However, the prognostic value of LAAWV in HF patients
remains uncertain and requires further investigation.
It has been seen that there is very limited published data on a
comparative study of LAAWV with all the other established parameters in
patients with heart failure. The primary objective of this study is to
determine the relationship between LAAW velocity obtained through
transthoracic tissue doppler echocardiography and conventional
echocardiographic parameters and serum biomarkers in patients with
ischemic and non-ischemic dilated cardiomyopathy.