testing in heart failure answers, answers, answers… shashank desai, md medical director, heart...

Testing In Heart FailureAnswers, Answers, Answers…

Shashank Desai, MDMedical Director, Heart Failure / Transplant Program

Inova Fairfax HospitalFalls Church, VA

Purpose of Testing

• Diagnosis – Why?• Prognosis – How Bad?• Therapeutics – What Next?

EchocardiogramUltrasound of the heart

size and shape of the heart squeezing function of the heartrelaxing function of the heartvalve functioning

Limited ability Coronary artery blockagePrognosis

Other Imaging Cardiac MRI

Nuclear Stress Testing and Coronary Angiography (left heart catheterization)

• Used to see if there is coronary artery disease as a cause

• Needed to determine if angioplasty or bypass surgery is helpful

• Limited in the ability to determine prognosis in heart failure

Cardiopulmonary Exercise Testing / Exercise VO2 test

• Ability to evaluate the heart’s peak capacity• Either with treadmill or bicycle• Uses the oxygen used and carbon dioxide

produced to assess the heart’s ability to perform• Very useful in determining short term prognosis• Prognosis similar to other exercise testing – six

minute walk test or regular treadmill

Right Heart Catheterization / Hemodynamics

• Used to assess the filling pressures and the heart output directly

• It can differentiate the reason for the heart failure to occur

• Hollow tube passed via a vein – neck, shoulder, arm, or groin

• Other end has a balloon at the tip• This floats through the right chambers of the

heart into the lung artery• Useful in diagnosis, prognosis, and

therapeutics

Blood Testing• Determine how good the other organs are functioning• Sodium (Na)• BUN• Creatinine (Cr)• Liver function tests

• Stress inside the heart• BNP• NT pro-BNP

Blood Testing• Scar inside the heart• Galectin 3

• Diagnostic blood tests• Thyroid Functions• Iron studies• HIV• Hepatitis B and C

Heart Biopsy• Routine use in

evaluation of heart failure is not done

• Only in cases of certain possible diseases that invade the heart and therapies would be different

At the time of diagnosis

• Echocardiogram• Blood testing• Stress test or coronary angiography• Maybe:– exercise testing– right heart catheterization– heart biopsy

Following heart failure over time

• Echocardiogram annually• Blood Testing routinely – often every 3 months• Coronary angiography / Stress testing if coronary artery

disease present and if new chest pains or if worsening situation

• Exercise testing – baseline and regularly over time - annually. This is based on the severity and degree of concern

• Right heart catheterization – baseline and usually when things are not going well. Routinely depending on severity

Questions?