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.