From the Guidelines
Transthoracic echocardiography (TTE) can determine ejection fraction (EF) as it provides an initial diagnosis and treatment plan in the majority of patients with suspected heart failure, including the quantification of chamber volumes, systolic and LV diastolic function, wall thickness, and identification of the aetiology of heart failure. The use of TTE for assessing myocardial structure and function, including EF, is supported by recent guidelines 1. According to the European Heart Journal, TTE is mandated in all patients with suspected heart failure to confirm or exclude the diagnosis and to identify the aetiology of heart failure 1.
Key Points
- TTE is recommended for the assessment of myocardial structure and function in subjects with suspected heart failure 1.
- TTE provides an initial diagnosis and treatment plan in the majority of patients with suspected heart failure 1.
- TTE can quantify chamber volumes, systolic and LV diastolic function, wall thickness, and identify the aetiology of heart failure 1.
- The 2016 ESC guidelines recommend TTE for the assessment of LVEF to identify patients with heart failure who would be suitable for evidence-based pharmacological and device treatment 1.
Given the information provided and the context of the question, TTE is a suitable diagnostic tool for determining EF in patients with suspected or established heart failure 1.
From the Research
Determining Ejection Fraction
- The study 2 found that the multiple diameter method can be used to determine ejection fraction (EF) by transthoracic echocardiography (TTE) with a nonvolumetric method.
- The method was validated for TTE and was also modified for transesophageal echocardiography (TEE), showing a strong correlation between EF by TTE and TEE (r = 0.98).
- The study 2 suggests that TTE can be used to determine EF, and the multiple diameter method is a viable option.
Ejection Fraction and Heart Failure
- The study 3 found that angiotensin-converting enzyme (ACE) inhibitors improve clinical outcomes in patients with ischemic cardiomyopathy and midrange EF (40-50%).
- The study 4 discusses the benefits of ACE inhibitors in patients with heart failure, including those with reduced EF, and highlights their role in preventing myocardial infarction.
- The study 5 found that ACE inhibitors reduce all-cause mortality and adverse events in patients with heart failure with reduced EF, with a number needed to treat (NNT) of 50 to avoid one death at 6 months.
- The study 6 discusses the benefits and limitations of ACE inhibitors in heart failure, including their ability to reduce cardiovascular mortality, myocardial infarction, and hospitalizations for heart failure.