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Echokardiographische Evaluation der systolischen linksventrikulären Funktion bei Herzinsuffizienz

Wertigkeit alternativer Parameter zur Bestimmung der Ejektionsfraktion

Echocardiographic evaluation of systolic left ventricular function in heart failure

Value of alternative parameters for determination of ejection fraction

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Zusammenfassung

Die Bestimmung der linksventrikulären Funktion ist eine zentrale Aufgabe der Echokardiographie in der Diagnostik der Herzinsuffizienz. Die etablierte Methode hierfür ist die Bestimmung der Ejektionsfraktion (EF) durch 2-D-Planimetrie mit der Scheibchensummationsmethode nach Simpson. Jedoch gibt es hierbei einige Limitationen, wie z. B. die Annahme einer geometrischen Symmetrie, die große Intra- und Interobservervariabilität, die ungenaue Bestimmung des linksventrikulären Volumens durch verkürzende Anlotung („foreshortening“) oder die eingeschränkte Schallbarkeit des Patienten. Zur genauen Bestimmung der linksventrikulären Funktion sollten deshalb ergänzend weitere echokardiographische Methoden herangezogen werden. Die Parameter der „Speckle-tracking“-Echokardiographie haben sich sowohl als wichtige prognostische Kenngrößen bei Herzinsuffizienz als auch zur differenzialdiagnostischen Abklärung bei Kardiomyopathien bewährt. Einfache und auch bei reduzierter Schallbarkeit anwendbare Marker für die linksventrikuläre Funktion sind die Bewegung des Mitralklappenanulus (MAPSE) und die Geschwindigkeit seiner Bewegung (Sm oder S‘). Bei einer Mitralklappeninsuffizienz hingegen kann die linksventrikuläre dP/dt als Ausdruck des Druckaufbaus im linken Ventrikel herangezogen werden. Nicht zuletzt ist die 3-D-Echokardiographie durch die Möglichkeit der dreidimensionalen EF-Bestimmung und der multivektoralen „Speckle-tracking“-Analyse ein wichtiges Werkzeug für die Evaluation der linksventrikulären Funktion.

Abstract

Assessment of the left ventricular ejection fraction plays a key role in the echocardiographic diagnosis of heart failure. The parameter most commonly used is the ejection fraction computed with the biplane disc summation method of Simpson; however, there are numerous limitations to this method, such as the assumption of geometrical symmetry, a substantial intraobserver and interobserver variability, foreshortening of the left ventricle and insufficient image quality for endocardial tracking. Alternative parameters for the evaluation of left ventricular function should be taken into consideration. Speckle tracking echocardiography has proven to be a reliable prognostic factor and a good tool for differentiating cardiomyopathies. Simple measurements, which are also feasible with poor image quality, are mitral annular plane systolic excursion (MAPSE) and the velocity of mitral annular movement (Sm or S’). In mitral regurgitation, left ventricular dP/dt represents the time to build up a certain pressure gradient and is therefore a measure of the contractile force exerted. Three-dimensional echocardiography has proven to be an important tool not only for three-dimensional measurement of the left ventricular ejection fraction but also for multivectoral speckle tracking analysis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. V. Dornberger, H.D. Dittrich und R. Busch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Innere Medizin B, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    V. Dornberger, H.D. Dittrich &  R. Busch

  2. Deutsches Zentrum für Herz-Kreislauf-Forschung, Standort Greifswald, Greifswald, Deutschland

    V. Dornberger, H.D. Dittrich &  R. Busch

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  1. V. Dornberger
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Correspondence to R. Busch.

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Dornberger, V., Dittrich, H. & Busch, R. Echokardiographische Evaluation der systolischen linksventrikulären Funktion bei Herzinsuffizienz. Herz 40, 185–193 (2015). https://doi.org/10.1007/s00059-015-4205-7

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