1. Testing In Heart Failure Answers, Answers, Answers… Shashank Desai, MD Medical Director, Heart Failure / Transplant Program Inova Fairfax Hospital Falls Church, VA

2. Purpose of Testing Diagnosis – Why? Prognosis – How Bad? Therapeutics – What Next?

3. Echocardiogram Ultrasound of the heart size and shape of the heart squeezing function of the heart relaxing function of the heart valve functioning Limited ability Coronary artery blockage Prognosis Other Imaging Cardiac MRI

4. 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

5. 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

6. 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

7. 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

8. Blood Testing Scar inside the heart Galectin 3 Diagnostic blood tests Thyroid Functions Iron studies HIV Hepatitis B and C

9. 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

10. At the time of diagnosis Echocardiogram Blood testing Stress test or coronary angiography Maybe: – exercise testing – right heart catheterization – heart biopsy

11. 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

12. Questions?