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shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

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World Journal of Methodology 2017年第4期7卷 117-128页

作者： Pupalan Iyngkaran nagesh s anavekar Christopher Neil Liza Thomas David L Hare Department of Medicine Northern Territory Medical School Flinders University Charles Darwin University Campus Department of Cardiology Northern Hospital Northern Health University of Melbourne Cardiology Unit Western Health Department of Medicine Western Precinct University of Melbourne south Western sydney Clinical school University of New South Wales Westmead Hospital Westmead Clincal School University of Sydney Cardiovascular Research University of Mel-bourne Heart Failure services Austin Health

The symptom cluster of shortness of breath(sOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with sOB.

关键词： Diastolic heart failure Exercise stress test Left atrium shortness of breath Work-up

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speckle Tracking for Assessment of Left Ventricular Dyssynchrony

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World Journal of Cardiovascular Diseases 2014年第4期4卷 149-155页

作者： Muhammad Asrar ul Haq Nima Rudd Ivan subiakto Peter Barlis nagesh s. anavekar Department of Cardiology The Northern Hospital Melbourne Australia

Cardiac resynchronization therapy (CRT) is an established therapy for selected heart failure (HF) patients to improve symptoms, ventricular function, and survival. Although increasingly used, left ventricular (LV) dyssynchrony assessment by echocardiography has failed to show enough predictive value to assess patient response to CRT and the current guidelines do not recommend its routine use. Furthermore, a variety of echocardiographic techniques used for the purpose, including tissue Doppler imaging (TDI), real time three-dimensional echocardiography, M-mode, and various Doppler parameters, showed limited value and poor agreement between the studies and methods, greatly influenced by interobserver variability. speckle tracking echocardiography (sTE) is a more recent approach that uses strain imaging to assess LV dyssynchrony. This article discusses the speckle tracking for LV dyssynchrony and its current clinical applications.

关键词： speckle Tracking sTE Dyssynchrony Echocardiography

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Therapeutic interventions for heart failure with preserved ejection fraction:A summary of current evidence

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World Journal of Cardiology 2014年第2期6卷 67-76页

作者： Muhammad Asrar ul Haq Chiew Wong Vivek Mutha nagesh anavekar Kwang Lim Peter Barlis David L Hare Department of Cardiology The Northern Hospital Department of Medicine University of Melbourne Department of Cardiology The Northern HospitalEpping

Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular *** of the current treatment of HFPEF is based on morbidity benefits and symptom *** pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for *** the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of *** present a brief overview of the currently recommended therapeutic options with available evidence.

关键词： Heart failure Diastolic dysfunction Heart failure with preserved ejection fraction Heart failure with normal ejection fraction

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