This is practical update on LV systolic function assessment in daily routine echo practice.

1. Vinayak Vadgaonkar
LV/RV SYSTOLIC FUNCTION -PRACTICAL ASSESSMENT

2. E-Point septal seperation
Normal 0.8-1cm

3. Teicholz method

4. Biplane Simpson,s 4 Chamber

5. Biplane Simpson,s 2 Chamber

6. Mitral annular plane systolic excursion
Normal value 12mm

7. Left ventricular mass and left ventricular mass
indexed to body surface area estimated by LV
cavity dimension and wall thickness at end-diastole
LV Mass (g) =
0.8{1.04[([LVEDD + IVSd +PWd]3 - LVEDD3)]} +
0.6.
Relative wall thickness (RWT) allows further
classification of LV mass increase as either
concentric hypertrophy (RWT >0.42) or eccentric
hypertrophy (RWT ≤0.42).
RWT =2 * PWd/LVEDD
Left ventricular hypertrophy

8. BSA 1.3 m2
LV mass 293 grams
LV mass index 224 grams/m2
RWT 0.23
Moderate eccentric hypertrophy

9. This patient’s S’ velocities in range of 3-5cm/s suggestive of severe LV systolic dysfunction
Normal S’ Velocity
>10cm/s

10. Myocardial performance index
“Tie index”
IVRT+IVCT/ET
Time from MVC to MVO-ET/ET
341ms-189ms/189ms
0.80

11. Stroke volume= Flow X Velocity
CSALVOTX VTILVOT
Πr2 X VTILVOT
O.785XD2 X VTILVOT
0.785X2.15X2.15X7.19 = 26ml
Cardiac Output = SV X HR
26ml X 94/min
2.4ml/min
Cardiac Index = 1.8ml/min/m2

12. LV Dp/Dt

13. LV sphericity index
Ratio of short axis to long axis
ratio in both systole and
diastole.Normal value

14. PLAX SAX mid PM view
Apical 4C LV focussed view
RWMA 1

15. Apical 3C view
Apical 2C view
True apex
LAD

16. PLAX SAX mid PM view
Apical 4C view
RWMA 2

17. Apical 4C LV focussed view Apical 3C view
Apical 2C view
RCA/LCX

18. LV functional anatomy
“The fundamental contractile unit of the cardiac myocyte, the sarcomere, is only capable of shortening by about 13%, wherea

19. Principle myocardial deformations
“The heart shortens and lengthens in the longitudinal direction, it thickens and thins in the radial direction, and it shortens and lengthens

20. Endocardial tracking

21. Informative graph with Polar,s bulbs eye map
Global longitudinal peak systolic strain -13.1%
Normal value (-20 to -25)%

22. 3D echo for LV volumes and EF

23. Comparable to CMR

24. LV cast

25. Proximal RVOT view Distal RVOT view
Apical 4C RV focussed view(RV inflow view)
Neglected ventricular function

26. Tricuspid annular plane systolic excursion RV free wall tissue doppler velocity
Normal value 1.7cm Normal value 9.5cm/s

27. RV End diastolic area RV End systolic area
RV fractional area change
(RV EDA - RV ESA/RVEDA)X100
(30.6 - 20.4/30.6)X100=33%

28. RV Myocardial performance index
“Tei index”

29. SAX AV-Distal RVOT
RVOT FUNCTION
1.RVOT Fractional shortening was defined as
RVOT FS = 100 × (RVOT ED − RVOT ES)/(RVOT ED).
Normal value <32%
2.RVOT Systolic excursion is defined as the SE of the
endocardial surface of the anterior RVOT wall relative to
the transducer.
Normal value <5mm

30. Stress Echo Case 1
Baseline
PLAX A4CV
A3CV A2CV

31. PEAK
PLAX
A4CV
A2CVA3CV
Positive/negative??

32. Stress echo case 2
Baseline
A2CV
SAX PM
A4CV
PLAX

33. Peak
Positive/negative??
PLAX
A3CV
SAX PM
A4CV

34. LV Dysynchrony

35. Atrioventricular dysnchrony

36. Septal to posterior wall motion delay

37. Interventricular mechanical delay
LVPEP RVPEP
IVMD 70ms

38. Speckle tracking echo in dysynchrony assessment