Contemporary clinical role of echocardiography in patients with advanced heart failure

Echocardiography represents an essential tool for imagers and clinical cardiologists in the management of patients with heart failure. Advanced heart failure (AdHF) is a more severe and, typically, later stage of HF that exposes patients to a high risk of adverse outcomes, with a 1-year mortality rate of around 50%. Currently, several therapies are available to improve the outcomes of these patients, reduce their mortality rate, and, possibly, delay the need for advanced therapies such as heart transplant and long-term mechanical circulatory support. When accurately performed and interpreted, echocardiography provides crucial information to properly tailor medical and device therapy of patients with AdHF and to identify those at even higher risk. In this review, we present the state of the art of echocardiography applications in the clinical management of patients with AdHF. We will discuss the role of echocardiography chronologically, beginning with the prediction of AdHF, proceeding through diagnosis, and detailing how echocardiography informs clinical decision-making, before concluding with indications for advanced therapies.

Graphical Abstract

The role of echocardiography in the management of patients with advanced heart failure. Echocardiography is a useful method for predicting the occurrence of AdHF during follow-up of patients with HF (top line). The diagnosis of AdHF requires an echocardiographic criterion for AdHF (middle line). In patients with AdHF, echocardiography is useful to identify patients who will benefit most from medical therapy adjustment, device therapy, and LVAD implantation. HF, heart failure; LA, left atrium; RV, right ventricle; LVEF, left ventricular ejection fraction. HF, heart failure; LA, left atrium; LVEF, left ventricular ejection fraction; RV, right ventricle