Rationale echokardiografische Funktionsdiagnostik

Die rationale echokardiografische Funktionsdiagnostik dient zur Analyse der myokardialen Herzfunktion sowie der Klappenfunktionen. Sie ermöglicht i. d. R. anhand reproduzierbarer standardisierter Bild-Dokumentationen richtige, nachvollziehbare Beurteilungen der Physiologie und Pathophysiologie des Herzens. Der Beitrag erklärt und diskutiert methodische Aspekte bei der Bestimmung bzw. Abschätzung wichtiger numerischer echokardiografischer Parameter.

Abstract

Functional diagnostics by rational echocardiography are the base of a verifiable and reliable analysis of ventricular and valvular function. The most important functional parameters in echocardiography are cardiac volumes – especially total and effective left ventricular stroke volume -, global longitudinal strain, effective orifica areas in valvular stenoses and effective regurgitant volumes, regurgitant fraction and regurgitant orifice areas in valvular regurgitations. Standardized documentation and correct measurements are the prerequisites for accurate echocardiographic estimations. In addition, optimization of image quality supports the correctness of measurements to ensure plausibility of hemodynamics in each individual patient. However, measurements of cardiac volumes by planimetry are error-prone. In addition, calculation of the effective orifice areas using the continuity equation needs methodological accuracy and standardization. Finally, assessment of regurgitant volumes, regurgitant fraction, and regurgitant orifice is often inconsistent with stable hemodynamic conditions – especially by functional assessment the 2D-PISA method. Thus, functional diagnostics by echocardiography in valvular heart diseases should focus on a plausible hemodynamic assessment.

Schlüsselwörter

Echokardiografie - Funktionsdiagnostik - Plausibilität

Key words

echocardiography - functional diagnostics - plausibility

Publication History

Article published online:
25 April 2022

• Literatur

• 1 Hagendorff A, Tiemann K, Simonis G. et al. Empfehlungen zur NotfallEchokardiografie. Kardiologe 2013; DOI: 10.1007/s12181-013-0531-2.
• 2 Hagendorff A, Stöbe S. Hrsg. Basiswissen Echokardiografie „Ars echocardiographica“ – Schritt für Schritt zur korrekten Diagnose. 2. Aufl.. München: Elsevier; 2021
• 3 Hagendorff A, Fehske W, Flachskampf FA. et al. Manual zur Indikation und Durchführung der Echokardiografie – Update 2020 der Deutschen Gesellschaft für Kardiologie. Kardiologe 2020; DOI: 10.1007/s12181-020-00402-3.
• 4 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imag 2015; 16: 233-270 DOI: 10.1016/j.echo.2014.10.003.
• 5 Rigolli M, Anandabaskaran S, Christiansen JP. et al. Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis. Open Heart 2016; 3: e000388 DOI: 10.1136/openhrt-2015-000388.
• 6 Voigt JU, Pedrizzetti G, Lysyansky P. et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 1-11 DOI: 10.1093/ehjci/jeu184.
• 7 Baumgartner HC, Hung JCC, Bermejo J. et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European association of cardiovascular imaging and the American society of echocardiography. Eur Heart J Cardiovasc Imaging 2017; 18: 254-275 DOI: 10.1093/ehjci /jew335.
• 8 Hagendorff A, Knebel F, Helfen A. et al. Expert consensus document on the assessment of the severity of aortic valve stenosis by echocardiography to provide diagnostic conclusiveness by standardized verifiable documentation. Clin Res Cardiol 2020; 109: 271-288 DOI: 10.1007/ s00392- 019- 01539-2.
• 9 Vahanian A, Beyersdorf F, Praz F. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; DOI: 10.1093/eurheartj/ehab395.
• 10 Minners J, Allgeier M, Gohlke-Baerwolf C. et al. Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis. Eur Heart J 2008; 29: 1043-1048 DOI: 10.1093/eurheartj/ehm543.
• 11 Kandels J, Tayal B, Hagendorff A. et al. „Pure“ severe aortic stenosis without concomitant valvular heart diseases: echocardiographic and pathophysiological features. Int J Cardiovasc Imaging 2020; DOI: 10.1007/s10554-020-01907-4.
• 12 Lancellotti P, Tribouilloy C, Hagendorff A. et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14: 611-644 DOI: 10.1093/ehjci/jet105.
• 13 Zoghbi WA, Adams D, Bonow RO. et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 2017; 30: 303-371 DOI: 10.1016/j.echo.2017.01.007.
• 14 Hagendorff A, Knebel F, Helfen A. et al. Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness. Clin Res Cardiol 2021; DOI: 10.1007/s00392-021-01841-y.
• 15 Hagendorff A, Doenst T, Falk V. Echocardiographic assessment of functional mitral regurgitation: opening Pandora’s box?. ESC Heart Fail 2019; 6: 678-685 DOI: 10.1002/ehf2.12491.
• 16 Hagendorff A, Knebel F, Helfen A. et al. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging 2021; 37: 183-196 DOI: 10.1007/s10554-020-01975-6.
• 17 Obadia JF, Messika-Zeitoun D, Leurent G. et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018; 379: 2297-2306 DOI: 10.1056/NEJMoa1805374.
• 18 Stone GW, Lindenfeld J, Abraham WT. et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 2018; 379: 2307-2318 DOI: 10.1056/NEJMoa1806640.