Heart failure is a complex clinical syndrome characterized by the inability of the heart to pump sufficient blood to meet the metabolic demands of the body or to do so only at elevated filling pressures. It represents a major global health problem, affecting millions of individuals and contributing significantly to morbidity, mortality, and healthcare expenditure. The prevalence of heart failure continues to rise due to aging populations, improved survival after myocardial infarction, and increasing burden of cardiovascular risk factors such as hypertension and diabetes mellitus [1]. Clinically, heart failure presents with symptoms such as dyspnea, fatigue, and fluid retention, which may result from structural or functional abnormalities of the heart. However, clinical assessment alone is often insufficient to determine the underlying cause, severity, and type of heart failure. Therefore, objective evaluation using imaging modalities is essential for accurate diagnosis and management [2]. Echocardiography has become the cornerstone in the evaluation of heart failure due to its non-invasive nature, wide availability, and ability to provide real-time information about cardiac anatomy and function. It allows comprehensive assessment of left ventricular systolic and diastolic function, chamber dimensions, wall motion abnormalities, and valvular lesions. Among these, measurement of left ventricular ejection fraction (LVEF) is of particular importance, as it helps classify heart failure into heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF), each having distinct therapeutic and prognostic implications [3]. In addition to evaluating systolic function, echocardiography plays a vital role in identifying the etiology of heart failure, such as dilated cardiomyopathy, ischemic heart disease, hypertensive heart disease, and valvular abnormalities. It also provides valuable information regarding hemodynamic status, including estimation of pulmonary artery pressure and assessment of diastolic dysfunction, which are important for guiding treatment decisions [4]. Recent clinical guidelines strongly recommend the use of echocardiography as a first-line investigation in all patients with suspected heart failure. It not only confirms the diagnosis but also aids in risk stratification and monitoring of disease progression and response to therapy [5]. Furthermore, echocardiography is useful in detecting complications such as intracardiac thrombi and pericardial effusion. A multidisciplinary approach involving clinicians and radiologists enhances the diagnostic accuracy and clinical utility of echocardiography. While clinicians provide detailed clinical assessment and correlate symptoms, radiologists contribute expertise in imaging interpretation, thereby improving overall patient care. Despite its widespread use, there is a need to evaluate the role of echocardiography in real-world clinical settings, particularly in tertiary care centres where a wide spectrum of heart failure patients is encountered. Hence, this study aims to assess the role of echocardiography in the evaluation of heart failure and its correlation with clinical findings.

Study Design and Setting This study was a prospective observational study conducted in a tertiary care teaching hospital. The study was carried out in collaboration between the Department of General Medicine and the Department of Radiology. The Department of General Medicine was responsible for clinical evaluation, diagnosis, and patient management, while the Department of Radiology performed and interpreted echocardiographic examinations. Study Duration The study was conducted over a period of 6 months. Study Population The study included patients presenting with signs and symptoms suggestive of heart failure who attended the outpatient department or were admitted to the inpatient services of the Department of General Medicine during the study period. Sample Size A total of 100 patients fulfilling the inclusion criteria were enrolled consecutively during the study period. Inclusion Criteria • Patients aged ≥18 years • Patients with clinical diagnosis of heart failure based on symptoms (dyspnea, fatigue, edema) and clinical examination • Patients willing to participate and provide informed consent Exclusion Criteria • Patients with congenital heart disease • Patients with poor echocardiographic window • Critically ill patients unable to undergo echocardiographic evaluation • Patients with incomplete clinical or imaging data Data Collection Procedure Data were collected using a pre-designed structured proforma. Each patient underwent detailed clinical and echocardiographic evaluation. Clinical Assessment: • Detailed history including onset and duration of symptoms • Physical examination including vital signs and cardiovascular examination • Functional classification using New York Heart Association (NYHA) classification • Relevant laboratory investigations (where available) Echocardiographic Assessment: Two-dimensional transthoracic echocardiography (2D Echo) was performed using standard equipment and protocols. The following parameters were assessed: • Left ventricular ejection fraction (LVEF) • Left ventricular dimensions and wall thickness • Regional wall motion abnormalities • Diastolic function • Valvular abnormalities (stenosis/regurgitation) • Presence of pericardial effusion LVEF was calculated using standard methods (e.g., Simpson’s method where applicable). Classification of Heart Failure Based on LVEF, patients were categorized as: • HFrEF (Heart Failure with reduced EF): <40% • HFmrEF (Mildly reduced EF): 40–49% • HFpEF (Preserved EF): ≥50% Statistical Analysis Data were entered into Microsoft Excel and analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Continuous variables were expressed as mean ± standard deviation (SD). Categorical variables were expressed as frequency and percentage. Chi-square test was used to assess association between categorical variables. A p-value < 0.05 was considered statistically significant Ethical Considerations • The study was conducted after obtaining approval from the Institutional Ethics Committee (IEC) • Written informed consent was obtained from all participants Patient confidentiality and anonymity were strictly maintained

A total of 100 patients with clinically diagnosed heart failure were included in the study. The majority of patients were in the age group of 51–70 years, with a mean age of 58.2 ± 10.5 years. Males were more commonly affected than females. Table 1: Demographic Characteristics of Study Participants (n = 100) Variable Category n (%) / Mean ± SD Age (years) Mean ± SD 58.2 ± 10.5 Gender Male 62 (62%) Female 38 (38%) Reduced ejection fraction (<40%) was observed in the majority of patients (62%), indicating a higher prevalence of heart failure with reduced ejection fraction (HFrEF). Table 2: Distribution of Ejection Fraction EF Category Number (n) Percentage (%) <40% (HFrEF) 62 62% 40–49% (HFmrEF) 18 18% ≥50% (HFpEF) 20 20% Dilated cardiomyopathy was the most common echocardiographic diagnosis, followed by ischemic heart disease and valvular abnormalities. Table 3: Echocardiographic Diagnosis Diagnosis Number (n) Percentage (%) Dilated cardiomyopathy 40 40% Ischemic heart disease 30 30% Valvular heart disease 20 20% Others 10 10% A statistically significant association was observed between reduced ejection fraction and increased clinical severity of heart failure (p < 0.001). Patients with EF <40% were more likely to present with severe symptoms. Table 4: Correlation Between Ejection Fraction and Clinical Severity (NYHA Class) EF Category Mild (Class I–II) Moderate (Class III) Severe (Class IV) p-value <40% 10 20 32 < 0.00 ≥40% 18 12 8

Heart failure remains a major cause of morbidity and mortality worldwide, necessitating accurate and timely evaluation for optimal management. In the present study, echocardiography proved to be an essential diagnostic tool, providing comprehensive information on cardiac structure, function, and underlying etiology . In this study, 62% of patients had reduced left ventricular ejection fraction (LVEF <40%), indicating a predominance of heart failure with reduced ejection fraction (HFrEF) . This finding is consistent with previous hospital-based studies, where systolic dysfunction constitutes the major proportion of heart failure cases [6]. The ability of echocardiography to accurately quantify LVEF makes it indispensable for classification of heart failure and guiding therapeutic decisions. The study also demonstrated that dilated cardiomyopathy was the most common echocardiographic finding (40%), followed by ischemic heart disease (30%) and valvular heart disease (20%) . This highlights the significant contribution of structural myocardial abnormalities to heart failure in this population. Similar patterns have been reported in earlier studies, where dilated cardiomyopathy and ischemic etiologies were identified as leading causes of heart failure [7]. A key finding of this study was the statistically significant association between reduced ejection fraction and clinical severity of heart failure (p < 0.001) . Patients with LVEF <40% were more likely to present with severe symptoms (NYHA Class III–IV), whereas those with preserved or mildly reduced ejection fraction had milder clinical presentations. This demonstrates a clear correlation between echocardiographic parameters and functional status, supporting the role of LVEF as a reliable indicator of disease severity [8]. In addition to systolic dysfunction, echocardiography enabled identification of valvular abnormalities and other structural changes contributing to heart failure. In patients with preserved ejection fraction (HFpEF), diastolic dysfunction plays a key role, and echocardiography remains the primary modality for its assessment [9]. Thus, echocardiography provides a comprehensive evaluation beyond mere measurement of ejection fraction. The findings of this study also emphasize the importance of echocardiography in identifying the underlying etiology of heart failure, which is crucial for appropriate management. Differentiating between cardiomyopathy, ischemic heart disease, and valvular pathology allows targeted therapy and improves clinical outcomes. Echocardiography also offers several practical advantages, including its non-invasive nature, wide availability, and ability to provide real-time assessment. It can be safely repeated for follow-up, allowing monitoring of disease progression and response to therapy without exposing patients to radiation [10].

Echocardiography is an indispensable tool in the evaluation of heart failure, providing detailed assessment of cardiac structure, function, and underlying etiology. It plays a crucial role in classifying heart failure based on ejection fraction and correlates well with clinical severity. The use of echocardiography facilitates accurate diagnosis and guides appropriate management. A collaborative approach between clinicians and radiologists further enhances diagnostic accuracy and improves patient care outcomes.

1. Braunwald E. Heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Elsevier; 2012. 2. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2012;33:1787–1847. 3. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure. Circulation. 2013;128:e240–e327. 4. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography. Eur Heart J Cardiovasc Imaging. 2015;16:233–270. 5. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for heart failure. Eur Heart J. 2016;37:2129–2200. 6. Redfield MM. Heart failure—an epidemic of uncertain proportions. N Engl J Med. 2002;347:1442–1444. 7. Dec GW, Fuster V. Idiopathic dilated cardiomyopathy. N Engl J Med. 1994;331:1564–1575. 8. Solomon SD, Anavekar N, Skali H, et al. Influence of ejection fraction on outcomes. Circulation. 2005;112:3738–3744. 9. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction. J Am Coll Cardiol. 2013;62:263–271. 10. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for evaluation of diastolic function. Eur J Echocardiogr. 2009;10:165–193.