Heart Failure Prediction via Pre-load ECG

All heart failure patients require quick and effective treatment. Those who exhibit mild symptoms yet have a poor prognosis, in particular, have to be identified because an aggressive approach is needed to increase their chances of a better outcome, health-wise.

According to a study published online in JACC: Cardiovascular Imaging, pre-load stress echocardiography using leg-positive pressure (LPP) is an effective way of improving heart failure prediction.

Specifically, transthoracic echocardiography with LPP helps by providing more prognostic information than the traditional Doppler echocardiography at rest among patients with mild heart failure.

Led by Hirotsugu Yamada of Japan’s Tokushima University Hospital, the team of researchers behind the study used the procedure in 202 patients diagnosed with chronic cardiac disease. Cardiac catheterization was also performed on 22 of the patients, whose left ventricular pressure was measured during LPP. There were also simultaneous Doppler recordings.

The patients were divided into three groups based on their left ventricular (LV) diastolic dysfunction, as determined via transmitral flow velocity. The categories were: restrictive or pseudonormal (PN) at rest, impaired relaxation (IR) at rest and during LPP (stable IR), and IR at rest and PN during LPP (unstable IR).

A comparison of the clinical outcome of the three groups revealed that variations in transmitral flow velocity during LPP can be used to estimate the LV end-diastolic pressure-volume relationship. That supports the efficacy of pre-load stress echocardiography with LPP in heart failure predictions of patients with mild symptoms. This ultimately allows doctors to present more informed findings relating to the prognosis of such cases.