The diagnosis of heart failure

Diagnosis of heart failure can be made if the following items are present:

In early stages of heart failure and in well-treated patients with heart failure, clinical signs of heart failure may not be present.

Structural cardiac abnormalities indicative of heart failure are usually diagnosed with echocardiography. These could be, for example:

a reduced LVEF < 55%.
a dilated left atrium. In the absence of AF or significant valvular disease, this is a sign of chronically elevated LV filling pressure.
LV hypertrophy. This is a LV muscle thickness > 12 mm.
signs of increased LV filling pressures such as an E/E' ratio > 9, pulmonary hypertension (pressure in the artery pulmonary > 35 mmHg at rest), …
engorgement or congestion of the inferior vena cava . This is a dilated inferior vena cava , possibly with reduced inspiratory collapse. This is a sign of increased CVP (central venous pressure).

Normotrophic and moderately dilated left ventricle (muscle thickness < 12 mm, end-diastolic LV diameter > 50 mm). Dilated cardiomyopathy.

Mitral valve inflow pattern (with Doppler) and movement of the lateral mitral valve annulus (E', with TDI). Increased LV pressures with E/A ratio > 1.5, shortened deceleration time ≤ 160 ms, E' < 8 and E/E' > 14.

Flow velocity of a tricuspid valve insufficiency (with Doppler) for measuring the pressure in the pulmonary artery. Pulmonary hypertension with peak flow velocity > 2.8 m/sec and calculated gradient 79 mmHg. Pulmonary pressure estimate is 79 mmHg + CVP.

Dilated inferior vena cava, indicative of increased pressure in the right atrium (central venous pressure, CVP). If respiratory variation on inspiration is preserved, CVP is estimated at 10 mmHg. If respiratory variation is reduced: CVP is approximately 15 mmHg. If there is no respiratory variation: CVP is approximately 20 mmHg.

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The diagnosis of heart failure

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The diagnosis of heart failure

Diagnosis of heart failure can be made if the following items are present: