A Contemporary Systematic Approach to Assessing the Patient with Heart Failure with Reduced Ejection Fraction: Multimodal Noninvasive and Invasive Evaluation

Figure 6

(a) Pathophysiology of dilated cardiomyopathy. The left ventricle reacts to an initial insult that decreases contractile force by increasing the end-diastolic volume (x-axis). Initially, left ventricular end-diastolic pressure (y-axis) remains low (<15 mmHg) and the patient remains asymptomatic (AHA class B). However, if progressive dilatation occurs, the end-diastolic pressure begins to rise with resultant dyspnea (AHA class C). Further deterioration leads to a reduction in stroke volume and inability to maintain necessary end-organ perfusion (AHA class D). (a) is found in Mayo Board Review as Figure 91.7 (page 849). (b) Transthoracic echocardiogram to determine RVEDP. Typically obtained in the parasternal short-axis view at the cardiac base, continuous-wave Doppler of the pulmonary regurgitant signal coupled with right atrial pressure can estimate pulmonary artery end-diastolic pressure (PADP) via . (b) is found in Mayo Board Review as Figure 79.7 (page 743). (c) Left ventricular (red) and pulmonary capillary wedge (PCWP) (green) tracings. Note the elevated left ventricular end-diastolic pressure (white arrow), elevated PCWP (green tracing) with prominent “v” wave (blue arrow).

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