Assessment of Left Ventricular Dysfunction and Remodelling by Determination of Atrioventricular Plane Displacement and Simplified Echocardiography

University dissertation from Ronnie Willenheimer, Department of Cardiologi, Malmö University Hospital, S-205 02 Malmö, Sweden

Abstract: Heart failure is a common disease characterised by poor prognosis and frequent hospitalisations, constituting a major economic burden to society. Mortality and morbidity can be reduced by optimal treatment, requiring objective evaluation of cardiac function and anatomy. The development of symptomatic HF can be prevented by initiating adequate treatment in early stages when LVD is still asymptomatic. Asymptomatic patients can be identified only by screening for LVD among patients at risk of developing HF, such as those with IHD, HT, and diabetes. However, there is a severe lack of resources to assess cardiac function and anatomy in all patients at risk. Consequently, many patients with latent HF will remain undetected, and in patients with symptomatic HF treatment will not be optimal.Simplified echocardiography, a 5-minute echocardiogram based on visual estimation of cardiac function and anatomy, is an inexpensive and accurate method for diagnosis and screening for latent and symptomatic HF. The long axis shortening of the LV is related to LV function and can be measured by AVPD. Determination of left AVPD is a reliable, reproducible, readily mastered, quickly performed and, therefore, inexpensive method that can be used in almost all patients for evaluation of LV function, as well as for prognostication in HF. Left AVPD reflects both systolic and diastolic LV function.Simplified echocardiography is useful for screening of asymptomatic patients at risk of developing HF, and for routine diagnostic purposes in patients with symptoms suggestive of HF. In patients with LVSD, simplified echocardiography may be combined with a determination of left AVPD for prognostication and for optimal detection of changes in LV function over time.

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