Ventricular Systolic Function In Patients Research Articles

Use of Speckle Tracking Echocardiography to Assess Left Ventricular Systolic Function in Patients with Surgically Repaired Tetralogy of Fallot: Global and Segmental Assessment.

Patients with repaired Tetralogy of Fallot (rToF) can have significant right and left ventricular dysfunction which can impact clinical outcome. Conventional echocardiographic evaluation using ejection fraction can be limited in detecting early stages of deteriorating left ventricular (LV) systolic function. Speckle-tracking echocardiography (STE) provides a promising emerging tool for early detection of LV systolic dysfunction. The aim of this cross-sectional study is to evaluate the left ventricular global and regional function using STE in rToF patients with preserved left ventricular ejection fraction to detect early signs of LV dysfunction. The study is a retrospective review of the medical records and transthoracic echocardiograms of rTOF patients who were seen in the pediatric cardiology clinic at our institution from August 2016 till May 2018. The rTOF group was compared with a matched healthy control group. Offline strain analysis of TTE studies was completed in each subject according to mode set by the American Society of Echocardiography. Twenty-two patients with rTOF and 22 age-matched controls (rTOF 18.7 ± 6years and control 14.6 ± 9.6 years, P value 0.19) were included during the study period. The rTOF group consisted of 12 males and 10 females, whereas the control group consisted of 15 males and 7 females. There was no significant difference in terms of LV ejection fraction using both 2-chamber as well as 4-chamber views. Global LV longitudinal strain was significantly lower in the rTOF group compared with the control group (rTOF - 15.92 ± 3.16 vs control - 22.79 ± 2.45, P value 0.00). All 17 segments showed significantly lower longitudinal strains in rTOF group compared with the control group. Global circumferential left ventricle strain was significantly lower in the rTOF patients compared with the control group (- 17.24 ± 5.86 vs - 22.74 ± 3.99, P value 0.001). 13 out of 16 segments had lower circumferential strains in the rTOF patients compared with controls. Asymptomatic surgically repaired TOF patients exhibited abnormal segmental and global left ventricle longitudinal and circumferential strains despite having normal left ventricle ejection fraction. Our findings suggest subclinical damage to the left ventricle systolic function post-surgical repair of TOF. 2-D speckle-tracking echocardiography may be used as a valuable method in the early recognition of left myocardial systolic function impairment in patients after TOF repair. The application of this method to guide clinical decision and management of rTOF patients such as earlier pulmonary valve replacement or risk stratification for sudden cardiac death needs further investigation.

Impact of abnormal longitudinal rotation on the assessment of right ventricular systolic function in patients with severe pulmonary hypertension.

Assessment of right ventricular (RV) function plays an important role in patients with cardiopulmonary disease, and current guidelines recommend parameters including tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') to assess RV longitudinal function. We assessed the hypothesis that the previously undescribed motion of RV longitudinal rotation (RVLR) is an independent predictor of both TAPSE and RVS'. We assessed a series of 100 consecutive patients with pulmonary hypertension (PH) undergoing echocardiography. Patients with left ventricular (LV) dilation and dysfunction were excluded. Standard RV parameters were determined using established guidelines, while RVLR and right ventricular global longitudinal strain (RVGLS) measurements were performed using 2-dimensional (2D) speckle tracking technique. Mean peak RVLR measured -4.2±3.7 degrees. By convention, negative values implied clockwise motion. In a multiple linear regression model, TAPSE could be predicted from a combination of RVLR and RVGLS (R=0.56, P<0.001). A similar relationship was found for RVS' which could also be predicted from a combination of RVLR and RVGLS (R=0.52, P<0.001). While no association was found between RVLR and RV size, estimated RV systolic pressure (RVSP) or the presence of a pericardial effusion, a mild correlation was noted between RVLR and QRS duration (R=0.25, P=0.01). RVLR is an independent predictor of TAPSE and RVS'. Awareness of this motion should be considered in the interpretation of TAPSE and RVS' values as markers of RV systolic function, as abnormal RVLR may account for exaggerated values, particularly in patients with PH and RV dysfunction.

P671Impaired left ventricular systolic function in patients with stenotic bicuspid aortic valve at the time of aortic valve replacement: a single-institution cohort of 425 patients

P671Impaired left ventricular systolic function in patients with stenotic bicuspid aortic valve at the time of aortic valve replacement: a single-institution cohort of 425 patients

OP-338 - The Association between Fragmanted Qrs and Left Ventricular Systolic Function in Patients with Erectile Dysfunction

OP-338 - The Association between Fragmanted Qrs and Left Ventricular Systolic Function in Patients with Erectile Dysfunction

Longitudinal layer-specific strain assessment of left ventricular systolic function of patients with coronary chronic total occlusion before and after revascularization

Objective To evaluate the longitudinal layer-specific strain of patients with coronary chronic total occlusion (CTO) before and 1 day after the percutaneous coronary intervention (PCI) by two-dimensional speckle tracking imaging (2D-STI), and then to explore the clinical value of PCI for patients with CTO. Methods A total of 30 patients diagnosed with CTO through coronary angiography and successfully taken the PCI procedure were enrolled in this study. Twenty-nine healthy volunteers were set as the control group. All patients were assigned to take echocardiography 1 day before and 1 day after PCI. The apical four-chamber (4CH), apical two-chamber (2CH) and the apical long-axis (APLAX) echocardiographic images of all subjects were acquired. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF) and stroke volume (LVSV) were measured. The mitral annular lateral S′, septal S′ and average S′ by tissue Doppler imaging (TDI) were also measured. The longitudinal layer-specific strain was analysed by 2D-STI. Results Compared to the control group, CTO group showed a decreased endocardial, midcardial and epicardial longitudinal strain of 4CH, 2CH and APLAX (P 0.05). All the other measures showed no significant difference among the three groups (P>0.05). Conclusions The longitudinal strain of patients with CTO is decreased compared to that of healthy people and increased after PCI. Key words: Echocardiography; Coronary occlusion; Speckle tracking imaging; Ventricular function, left

Clinical study on assessment of left ventricular systolic function in patients with hypertrophic cardiomyopathy by vector velocity imaging

Objective To analyze the strains of patients with hypertrophic cardiomyopathy (HCM) by vector velocity imaging(VVI), and to identify abnormal early systolic function. Methods Forty patients with HCM (HCM group) and 25 healthy subjects (control group) were enrolled. Standard two-dimensional echocardiography was performed. Left ventricular ejection fraction (LVEF), diameters and wall thickness were measured. Peak systolic strains in all directions and their time to peak were analyzed off-line. Results ①All but the endocardial circumferential strain were apparently smaller in HCM group than those in the control group(P<0.000 1). The difference was greater in long axis than that in short axis. ②The HCM group maintained the characteristics of strain gradient as the control group, including the endocardium-epicardium gradient with endocardial strains was significantly greater than epicardial ones and the base-apex gradient, among which epicardial longitudinal strain decreased from the base to the apex and endocardial circumferential strain increased toward the apex. ③The HCM group suffered significant dyssynchrony in terms of strain and rotation, with greater changes in longitudinal than in short axis, in epicardium than in endocardium. Conclusions VVI offers an overall assessment of regional and global left ventricular systolic function, including longitudinal and circumferential strain. Moreover, it can be used to evaluate subclinical systolic dysfunction and dyssynchrony in patients with HCM. Key words: Echocardiography; Ventricular function, left; Cardiomyopathy, hypertrophic; Strain; Vector velocity imaging

Right ventricular systolic function in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis

BackgroundRight ventricular (RV) systolic dysfunction is associated with worse survival in patients undergoing surgical aortic valve replacement (SAVR), yet it is not included in traditional risk scores of transcatheter aortic valve implantation (TAVI) candidates. We aimed to evaluate the prognostic value of RV systolic function on clinical outcomes in patients undergoing TAVI at one year follow-up; and, echocardiographic changes of RV systolic function up to 12 months after TAVI and compared with SAVR when possible. Methods and resultsThis systematic review and meta-analysis is registered in PROSPERO (CRD42017065761). Studies investigating RV systolic function with echocardiography in TAVI cohorts were identified from Medline, Embase and Cochrane databases. We used random-effects models to assess differences in primary outcomes. Twenty-one studies were identified, where RV systolic function and clinical outcomes were assessed in eight (4016 patients) and RV systolic function changes were evaluated in 14 (1709 patients). For the primary outcome of all-cause death at one year, RV systolic dysfunction was associated with a significant 78% relative risk increase (risk ratio[95% confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit significant heterogeneity (I2 = 64%, P < 0.01). RV systolic function was unchanged after TAVI throughout follow-up as shown with tricuspid annular plane systolic excursion (TAPSE)(mean difference[95% CI]pre-discharge = 0.03 [−0.92,0.99]mm,1–3 months = −0.09[−0.89,0.71]mm,6–12 months = 0.52 [−0.29,1.32] mm, all P = NS), while TAPSE was significantly reduced after SAVR (pre-discharge = −10.17[−13.11,−7.24]mm, P < 0.01;1–3 months = −7.3[−8.17,−6.44]mm, P < 0.01;6–12 months = −5.99[−7.95,−4.03]mm, P < 0.01). ConclusionsRV systolic dysfunction was associated with a significant increase in all-cause mortality at one year after TAVI. RV systolic function was unchanged after TAVI up to 12 months, whereas deteriorated significantly after SAVR.

Accuracy of echocardiographic indices for serial monitoring of right ventricular systolic function in patients with precapillary pulmonary hypertension.

BackgroundSerial assessment of right ventricular ejection fraction (RVEF) predicts the clinical outcome of patients with pulmonary hypertension (PH). Cardiac magnetic resonance imaging (CMRI) enables RVEF monitoring, but its applicability is limited in clinical practice. This study aimed to examine the correlation between changes in CMRI-derived RVEF with those in echocardiographic indices in patients with precapillary PH.MethodsCMRI and echocardiographic indices of RV systolic function were evaluated at baseline and follow-up in 54 consecutive patients with precapillary PH (pulmonary arterial hypertension (PAH), n = 23; non-PAH, n = 31). During follow-up, medical treatment was optimized according to the guidelines for PH. Using CMRI-derived RVEF as the gold standard, we examined the accuracy of five echocardiographic indices by correlation analysis and receiver operating characteristic (ROC) analysis and by calculating sensitivity, specificity, and positive and negative predictive values.ResultsAfter an average period of 9.5 months, CMRI-derived RVEF improved from 30.2% ± 10.6% at baseline to 41.4% ± 11.3% at follow-up. These changes significantly correlated with those in the five echocardiographic indices, i.e., %RV fractional shortening (r = 0.27), %RV area change (r = 0.46), tricuspid annular plane systolic excursion (TAPSE) (r = 0.84), RV myocardial performance index (RVMPI) (r = −0.72), and systolic lateral tricuspid annular motion velocity (TVlat) (r = 0.66). Of these indices, %RV area change, TAPSE, and TVlat significantly correlated with those of CMRI-derived RVEF in both PAH and non-PAH subgroups. ROC analysis showed that improvement in echocardiographic indices predicted a pre-specified improvement in CMRI-derived RVEF (>2.9%), with TAPSE and TVlat showing better accuracy over the other three indices.ConclusionsEchocardiographic indices modestly correlate with the changes in CMRI-derived RVEF in precapillary PH patients. Comparison among the five echocardiographic indices revealed that TAPSE and TVlat provide better accuracy than %RV fractional shortening, %RV area change, and RVMPI.

Two-dimensional speckle tracking imaging in assessing the left ventricular systolic function and its dynamic changes of patients with septic shock

To evaluate early and dynamic changes of the left ventricular systolic function of patients with septic shock by two-dimensional speckle tracking imaging (2D-STI), and to provide guidance for treatment and prognosis. Fifty-eight septic shock patients admitted to intensive care unit (ICU) of Subei People's Hospital from January 2016 to April 2017 were enrolled. The septic shock patients were given early fluid resuscitation. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), early diastolic mitral flow velocity/early diastolic mitral annular peak velocity (E/Em) were obtained by conventional echocardiography, and the left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) were obtained by 2D-STI before fluid resuscitation and 1, 3, 7, 14 days after fluid resuscitation. According to the 28-day survival, the septic shock patients were divided into survival group (38 cases) and death group (20 cases). Thirty normal subjects with age and sex matched were selected as control group. (1) Compared with control group, heart rate (HR) and LVESV were increased [HR (bpm): 92.71±12.51 vs. 73.07±5.52, LVESV (mL): 42.50±7.89 vs. 38.73±4.23, both P < 0.05], while LVEF, GLS, GCS were decreased [LVEF: 0.57±0.06 vs. 0.61±0.03, GLS: (-17.72±1.35)% vs. (-22.07±1.95)%, GCS: (-17.08±1.49)% vs. (-22.98±1.97)%] in septic shock group (all P < 0.01). (2) Compared with the data before fluid resuscitation, heart rate was declined (bpm: 87.83±11.50 vs. 92.71±12.51, P < 0.01), while LVEDV and LVEF were increased [LVEDV (mL): 102.32±9.23 vs. 99.24±8.86, LVEF: 0.59±0.05 vs. 0.56±0.06] in patients of the septic shock after fluid resuscitation (all P < 0.01). (3) With the extension of treatment time, HR, LVEDV, LVESV, E/Em were increased gradually, and LVEF, GLS, GCS, GRS were decreased gradually in dead patients. In septic shock patients, compared with survival group, GCS was significantly different on day 1 [(-15.98±1.41)% vs. (-17.66±1.22)%, P < 0.05], HR, LVEDV, LVESV, GLS were significantly different on the 3rd day [HR (bpm): 104.60±10.94 vs. 88.71±5.06, LVEDV (mL): 109.69±10.00 vs. 103.99±5.74, LVESV (mL): 47.78±7.21 vs. 42.29±5.13, GLS: (-14.44±0.92)% vs. (-16.36±1.00)%, all P < 0.05], LVEF, GRS were significantly different on the 7th day [LVEF: 0.47±0.07 vs. 0.58±0.04, GRS: (28.27±3.23)% vs. (31.48±3.12)%, both P < 0.05], and E/Em was significantly different on the 14th day (12.81±1.56 vs. 10.61±1.27) in dead group (P < 0.05). Our study demonstrates myocardial dysfunction at the early phase in septic shock patients, and 2D-STI GCS can be more sensitive than the conventional echocardiography to determine prognosis. 2D-STI GCS, GLS, GRS were not volume-load dependent parameter. Low levels of GLS, GCS might suggest a poor prognosis.

P1431Right ventricular strain of a line segment as a feasible parameter of right ventricular systolic function in patients with advanced heart failure referred for left ventricular assist device therapy

P1431Right ventricular strain of a line segment as a feasible parameter of right ventricular systolic function in patients with advanced heart failure referred for left ventricular assist device therapy

P1073Myocardial edema still remains in subacute phase after recovery of left ventricular systolic function in patients with takotsubo syndrome

P1073Myocardial edema still remains in subacute phase after recovery of left ventricular systolic function in patients with takotsubo syndrome

Dynamics of indicators of longitudinal left ventricular systolic function in patients with acute myocardial infarction during stress echocardiography with dobutamine

Aim: to study the dynamics of longitudinal left ventricular systolic function during stress echocardiography with small doses of dobutamine in patients with acute myocardial infarction

3868Different prognostic impacts of residual coronary stenosis after percutaneous coronary intervention by left ventricular systolic function in patients with ischemic heart failure

3868Different prognostic impacts of residual coronary stenosis after percutaneous coronary intervention by left ventricular systolic function in patients with ischemic heart failure

Ultrasonic research on the correlation between aortomitral angle and left ventricular systolic function in the patients with ischemic cardiomyopathy

Objective To evaluate the relationship between the change of the aortomitral angle (AMA) with left ventricular systolic function in patients with ischemic cardiomyopathy (ICM) by echocardiography. Methods Thirty-one patients were enrolled in the ICM group, and 59 healthy subjects were selected as the control group. On the parasternal left ventricular long axis plane, AMA were measured at the R wave apex (R-AMA), J-point(J-AMA), ST-segment midpoint(ST-AMA), T-final wave (T-AMA) and P-final wave (P-AMA). The angle difference(⊿θ)=AMAmax-AMAmin, the angle changing rate =⊿θ/AMAmax. The global left ventricular longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by 2D-speckle tracking echocardiography. Left ventricular ejection fraction(LVEF), left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were measured using Simpson biplane method. Results The J-AMA was the largest in the control group, while the ST-AMA was the largest in the ICM group. The levels of LVEDV, LVESV and AMA in ICM group were significantly higher than those in control group, while LVEF, GLS, GCS, ⊿θ/AMAmax and ⊿θ were decreased (P<0.05). In the control group, there was a correlation between T-AMA and LVEF (r=-0.349, P=0.007), and ⊿θ was negatively correlated with GLS (r=-0.372, P=0.004). In the ICM group, ⊿θ/AMAmax and ⊿θ were correlated with LVEF (r=0.424, P=0.018; r=0.490, P=0.005). Conclusions AMA in ICM patients is significantly increased. The angle difference and the rate of its change are closely related to the LVEF, which is a manifestation of three-dimensional structure change of the myocardial. Key words: Echocardiography; Ischemic cardiomyopathy; Aortomitral anlge; Ventricular function, left

Plasma dipeptidyl-peptidase-4 activity is associated with left ventricular systolic function in patients with ST-segment elevation myocardial infarction

Plasma dipeptidyl-peptidase-4 activity (DPP4a) is inversely associated with left ventricular function in patients with heart failure (HF) or diabetes. However, the association between DPP4a and left ventricular function in ST-segment elevation myocardial infarction (STEMI) patients has not been reported. We studied this association in 584 consecutive STEMI patients at a tertiary referral center from July 2014 to October 2015. DPP4a and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels were quantified by enzymatic assays. The median serum NT-proBNP levels were highest in patients of the lowest tertile (T1) of DPP4a compared with that of the highest tertile (T3) (p = 0.028). The STEMI patients in T1 exhibited lower left ventricular systolic function (T1 vs. T3: left ventricular ejection fraction (LVEF): 50.13 ± 9.12 vs. 52.85 ± 6.82%, p = 0.001). Multivariate logistic-regression analyses (adjusted for confounding variables) showed that a 1 U/L increase in DPP4a was associated with a decreased incidence of left ventricular systolic dysfunction (LVSD) (adjusted odds ratio: 0.90; 95% CI: 0.87–0.94; p < 0.01). In conclusion, low DPP4a is independently associated with LVSD in STEMI patients, which suggests that DPP4 may be involved in the mechanisms of LVSD in STEMI patients.

Assessment of sustained effects of levosimendan on right ventricular systolic functions in patients with advanced heart failure.

Background Poor right ventricular function is an independent prognostic marker for mortality in heart failure patients. Echocardiographic studies concerning effects of levosimendan on right ventricular function performed second measurements just after or 24 hours after levosimendan infusion. We aimed to detect sustained effects of levosimendan infusion on right ventricular systolic function.Method The study consisted of 47 patients with acutely decompensated heart failure with NYHA class III or IV symptoms. Levosimendan was infused for 24 hours. Before and 5 days after the initiation of infusions, functional class was assessed, NT-proBNP levels and LVEF, RVEF, using tissue Doppler imaging, RV isovolumic myocardial acceleraton (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E’) and late (A’) diastolic velocities, and E’/A’ ratio were measured.Results NYHA class improved and NT-proBNP levels were significantly reduced. LVEF and ...

Clinical imaging in patients experiencing chest pain.

Non-invasive imaging modalities integrate the clinical and laboratory diagnostic work-up of patients admitted in emergency department for chest pain. Transthoracic echocardiography is the first-line imaging tool because it is rapidly and widely available, bedside feasible and cost-effective. Even when a comprensive exam is not feasible, a fast focused ultrasound exam should be performed. Contrast enhanced computed tomography is an easily accessible tool with specific application in patients suspected for pulmonary embolism (PE) and acute coronary syndrome (ACS) according to the pre-test risk assessment and to the clinical status. Cardiac magnetic resonance is not yet very widespread, takes a long time and requires quite stable hemodynamic and clinical condition. It provides accurate information on ventricular systolic function in patients with inadequate echocardiographic windows and gives the unique opportunity to obtain myocardial tissue characterization data that may be diriment in diseases such as ACS, myocarditis and Takotsubo syndrome. Nuclear imaging modalities are generally not available on 24 h service but can be useful in doubtful cases of ACS and PE. Shared diagnostic protocols are the cornerstone of a good practice in emergency rooms and chest pain units. Physician should be familiar with the indication for urgent non-invasive imaging exams in patients admitted for chest pain, in order to achieve rapid diagnosis and start a prompt and proper therapy. Moreover, they should balance identification of critical patients with the safe and early discharge, directly from the emergency room, of low-risk subjects with no evidence of disease.

Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy.

The aim of this study was to investigate the usefulness of three-dimensional (3D) speckle tracking echocardiography (STE) for assessment of both left and right ventricular systolic function in patients with lymphoma after anthracycline chemotherapy, compared with two-dimensional (2D) STE. Totally eighty-nine patients undergoing anthracycline containing chemotherapy were studied. Echocardiographic assessment included 2D and 3D left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS) and right ventricular (RV) GLS. All the parameters were analyzed at baseline, after the completion of four cycles and at the end of the regimen respectively. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic parameters to discriminate between before and after chemotherapy. Compared with those at baseline, the 3D GLS and GCS of LV and GLS of RV decreased significantly after four cycles of the therapy (all p < 0.01). At the end of the treatment, 2D GLS and GCS of LV deteriorated markedly (both p < 0.05). The area under the curve for GLS, GCS of LV and GLS of RV derived by 3D were 0.81, 0.66 and 0.78, respectively. The cutoff value with -20.4% of LV GLS by 3D had sensitivity of 81% and specificity of 66% for differentiating patients after therapy from baselines. The cutoff value with -21.9% of RV GLS by 3D had sensitivity of 71% and specificity of 74% fordifferentiating patients after therapy from baselines. The data from this study demonstrated that both 2D and 3D STE can be conducted to evaluate the slight myocardial damage for lymphoma patients after anthracycline chemotherapy. 3D STE could examine subclinical biventricular dysfunction in earlier point than 2D STE.

Assessment of regional right ventricular systolic function in patients with obstructive sleep apnea syndrome using velocity vector imaging

[This corrects the article DOI: 10.1097/MD.0000000000004788.].

Systolic mitral annulus velocity is a sensitive index for changes in left ventricular systolic function during inotropic therapy in patients with acute heart failure.

Echocardiography is recommended for assessment of left ventricular systolic function in patients with acute heart failure but few randomised trials have validated techniques like tissue Doppler (TDI) and speckle tracking (STE) in patients with acute heart failure following ST-elevation myocardial infarction. This was a substudy from the LEAF (LEvosimendan in Acute heart Failure following myocardial infarction) trial (NCT00324766 ), which randomised 61 patients developing acute heart failure, including cardiogenic shock, within 48 hours after ST-elevation myocardial infarction, double-blind to a 25-hour infusion of levosimendan or placebo. TDI-derived systolic mitral annulus velocity (S'), STE-derived global longitudinal strain (Sl) and strain rate (SRl) were measured at baseline, day 1, day 5 and after 42 days. Datasets rejected for analyses were 2% (TDI) and 17% (STE). S' increased by 23% in the levosimendan group versus 8% in the placebo group from baseline to day 1 ( p= 0.011) and by 30% vs. 3% from baseline to day 5 ( p <0.0005). Significant, but less pronounced, improvements in global Sl ( p = 0.025 and p = 0.032) and in global SRl ( p = 0.046 and p = 0.001) in favour of levosimendan were also present. S' by TDI and STE-derived Sl and SRl were sensitive indices for changes in left ventricular systolic function related to treatment with levosimendan. However, S' by TDI was more feasible and sensitive and might be preferred for assessment of changes in left ventricular systolic function in critically ill patients with acute heart failure receiving inotropic therapy.