[Revisiting the clinical examination of the patient with heart failure in the light of data obtained with Doppler echocardiography].

Echocardiography plays a central role in the diagnosis and assessment of heart failure as it allows us to discover missed valvular or congenital heart disease and distinguishes the different pathophysiological forms of cardiomyopathies. Echocardiographic examination shows the presence, the severity and the mechanism of mitral regurgitation. It identifies the pathophysiology of heart failure differentiating systolic from diastolic dysfunction. The different patterns of Doppler transmitral flow curves are correlated with left ventricular filling pressures and with functional capacity of the patient. The assessment of functional impairment of the patient is based not only on the measurement of left ventricular volumes and ejection fraction, but rather on an integrated analysis of several clinical and echocardiographic features including right ventricular volumes and ejection fraction. Prognostic information can be obtained from the echocardiographic examination: a short (< 125 ms) deceleration time of early filling in transmitral flow curve and its persistence despite optimized medical treatment identify patients at very high risk of subsequent death and/or hospitalization. Similarly, pulmonary hypertension measured by Doppler echocardiography is a predictor of poor outcome. Since Doppler echocardiographic assessment of hemodynamic variables in patients with advanced heart failure is accurate and reproducible, this non-invasive methodology may assist with monitoring and optimizing medical therapy in such patients. The symptoms of heart failure as well as the clinical and radiographic findings are neither sensitive nor highly specific to diagnosis. Furthermore clinical findings are not reliable for estimating hemodynamics of the individual patient. At present, the echocardiogram is the most useful and widespread tool used in heart failure patients, with regard to diagnosis, assessment and hemodynamic characterization. Due to the complex nature of the heart failure syndrome, for an exhaustive assessment of the patient, echocardiographic data should be integrated with clinical and laboratory findings.