By Sruthi Meenaxshi

1. Echocardiographic
evaluation of left
ventricular systolic
function
By Dr. Sruthi Meenaxshi MD, PDF

2.  Assessment of left ventricular (LV) systolic function is
important for diagnosis, management, follow-up, and
prognostic evaluation of patients in a variety of clinical
settings

3. INDICATIONS
 Signs and symptoms of heart disease.
 Signs or symptoms suggestive of heart disease such as
unexplained electrocardiographic abnormality, palpitations,
stroke, or peripheral embolic event.

4.  Signs or symptoms of heart failure (HF).
 Information on LV systolic function as well as diastolic function
 chamber geometry
 regional wall motion
 valve function is important for diagnosis and management
 Among patients with HF, left ventricular ejection fraction (LVEF) Is used to
identify categories of HF with preserved ejection fraction (HFpEF; LVEF ≥50
percent), HF with reduced ejection fraction (HFrEF; LVEF ≤40 percent)

5.  Signs or symptoms of coronary artery disease. Assessment
of regional and global LV systolic function is commonly
combined with stress testing.
•The presence of ventricular arrhythmias is a common
indication for evaluation of LV function and structure as part
of an evaluation to determine whether there is a structural
cause for the arrhythmia.

6. DSE showing biphasic response

7.  Planned or prior exposure to potentially cardiotoxic
therapy.
 Patients undergoing treatment with potentially cardiotoxic
therapy require serial evaluation of LV systolic function for
early detection of cardiotoxicity

8.  Transthoracic echocardiography (TTE) is the most
commonly preferred initial imaging modality to assess LV
systolic function.

9. Normal LV systolic function

10.  Patients who require serial evaluations of LV systolic
function (eg, patients undergoing potentially cardiotoxic
chemotherapy) volumetric (3D) methods are preferred for
serial evaluation and detection of small changes .

15.  The use of harmonic imaging and echocardiographic
contrast media have been shown to significantly improve
image quality for assessment of LV systolic functional
parameters, particularly in patients with poor acoustic
windows

17. LV Dimensions by M mode
 The ASE recommends measurement of LV dimensions with
Mmode line perpendicular to long axis of the heart
immediately distal to tips of Mitral valve leaflets in
parasternal long axis view

19. M mode assessment of LV
systolic function

20. E point septal separation(EPSS)

21. Mitral Annular plane systolic
excursion(MAPSE)

22. M mode through aortic valve in
patient with reduced cardiac
function

23. Assessment of LV volume
 Several methods have been proposed for the quantitative
assessment of LVEF.
 The biplane method of discs (modified Simpson method)
using area tracings of the LV cavity is the preferred 2D
method for LV volume quantification and measurement
of LVEF

26.  Regional evaluation of LV function is commonly determined
based on qualitative visual assessment of wall
thickening and endocardial motion of each myocardial
segment visualized in multiple views.
 Seventeen- or 16-segment models of the heart are
recommended

27. 17 segment model

29.  ASE guidelines recommends the 16-segment model for routine
assessment of wall motion due to limited endocardial excursion
and thickening at the tip of the apex
 ASE guidelines also recommend use of a semiquantitative wall
motion score
 1-normal or hyperkinetic
 2-hypokinetic [reduced thickening],
 3-akinetic [absent or negligible thickening], and
 4-dyskinetic [systolic thinning or stretching]) assigned to each
segment for calculation of LV wall motion score index as the
average of scores of all visualized segments

30.  Newer echocardiographic techniques using tissue Doppler imaging and
speckle tracking echocardiography can directly obtain information on
myocardial contractility, including myocardial velocities, strain, and
strain rate.
 These methods allow for assessment of the various components of
contraction, including radial, longitudinal, and circumferential
contraction, allowing for assessment of global and regional systolic
function
 Parameters such as global longitudinal strain may prove to be more
sensitive for detection of decreased LV function than traditional
measures of LVEF , and have been recommended as an alternative
clinical technique that offers incremental prognostic information over
LVEF