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QUANTIFICATION OF THE LEFT
VENTRICULAR FUNCTION BY
DIFFERENT METHODS
Prof.E.Srbinovska Kostovska MD, PHD, FESC
Nothing to declare
Quantification of LV function
 Part of routine
echocardiography
examination
 TTE is the most common
used technique for
quantitative estimation
 Huge impact on clinical
decisions making and
follow up
 provide important
prognostic information
Why assessment
of LV function
Determinants of
left
ventricular
performance
M - mode echocardiography
EF – quantitative approach of LV function,
defined by the fraction of volume ejected
during each ventricular contraction
 M-mode echocardiography provide an
adequate measurement of LV function in the
presence of normal geometry and symmetric
function
 Linear line has to be perpendicular to the long
axis of the left ventricle
Linear measurement obtain
- 2D guided M mode
measurements -
EF (%)= (LVEDd-LVESd)/LVEDd*100
Underestimation/overestimation of LV dimension
- Pericardial tamonada or constriction
- RV overload
- LBBB
- Non-compaction cardiomyopathy
- Muscular bend
Muscular
bend
Intraventricular dyssinchrony
Other M-mode measurements
 Fractional shortening
(%)
 > 25% in men and >
27%in women
 In normal geometry
and symmetric
function
 Distance between the
E point of the
anterior mitral leaflet
and the basal portion
of the interventricular
septum
MAPSE – mitral annular plane
systolic function
 Quantitative
assessment of LV
longitudinal
function
 Directly
proportional to
systolic function
Two dimensional echocardiography
assessment of the LV
 Qualitative assessment
 Normal, Hyper-dynamic, depressed
 Depressed- mild, moderate, severe
 Quantitative assessment
 Biplane method of disk (modified Simpson.s
rules)
 Area length method
Normal value and severity partition
cut-off values for 2D derived LV
EF(%)
2D echocardiography
Noncompaction cardiomyopathy
Stoke volume – N 50-80ml
- afterload dependant parameter
 2D echocardiography – biplane Simpson's
methods ( LVEDvol-LVESvol)
 3D echocardiography full volume
echocardiography
 Doppler echocardiography
 LVOT tract area
 LVOT time velocity integral
3D echocardiography
 Highly accurate and reproducible of global
and regional assessment of the left ventricle
 Do non rely on geometrical assumption
 Two approaches used for 3D LV quantification
 3D guided biplane technique
 Direct volume calculation based on
semiautomated detection of endocardial surface,
followed by calculation of volume
3D echocardiography
3D measurements are comparabile
with MRI
Sugeng Circ.2006; 114:654
Doppler Evaluation - dp/dt of the MR
* represent LV contractility
Limitation- Eccentric jets
- Load dependent ( in patients wit hypertension
Normal value > 1200 mmHg/s
and Ao stenosis can be normal even in impaired LV Impaired < 1000 mmHg/s
- heart rate dependant
Tissue Doppler imaging –
measures myocardial motion velocity
- Global longitudinal systolic function ( S < 0,6m/s)
- Regional function by velocity – placing the
sample volume in the region of interest
- Angle dependent
Normal velocity range in TDI
Tissue Doppler imaging
Tissue Doppler imaging
Left vetricular
dyssinchrony
Myocardial performance index
TEI index
 MPI = IVCT+IVRT/ EF
 Reflects global systolic and diastolic LV
performance
 Systolic dysfunction causes a prolonged IVCT
 Diastolic dysfunction prolongs IVRT
 N value > 0,4
Myocardial performance index
TEI index
TDI
Doppler
echocardiography
2D speackle tracking (STI)
Technique for quantification of multidirectional myocardial
strain
 Speckles are natural acoustic markers that occur as small
and bright elements in conventional gray scale
 The speckles are back scattered from the structures smaller
than a wavelength of ultrasound.
 Speckles are distributed all through the myocardium on the
ultrasound image
Arch Cardiol Mex. 2011;81:114-125

Speacle tracking vs TDI
 Deformation from
myocardial tissue markers
 Angle independent
 Strain in 3 spatial
directions
 Myocardial velocity
 Angle dependency
 Strain along beam
direction only
2D speckle tracking (STI)
- longitudinal deformation
- circumferential deformation
- radial deformation
Longitudinalen strain
2D biplane EF and 2D Spackle tracking estimated GLVSS
-reflects different aspects of systolic LV function
Accuracy of LV EF biplane (Simpson role):
- imaging quality dependence
- variability of EF to inaccurate border tracking
- load dependant
- insensitivity to early disease
Benefits of 2D Spackle tracking estimated GLVSS:
- calculated directly by the software
- when endocardial border is not well defined
- less load dependent in terms of EF
- subclinical LV heart failure
- LBBB and tethering effects of adjanced
myocardial segments
There is a good correlation between GLVSS and
LVEF calculated using the 2D biplane method
(Simpson's rule)
 Strain – calculates contractility
of the myocardium
Early stage of dysfunction
 EF – describes myocardial
pump function
Tasce et al.Cardiovascular Ultrasound 2007, 5-27
GLVSS is compared to EF from both methods, echo and
angiography, but also to other hemodynamic echo
parameters
GLVSS was significantly lower in patients
with
EF below 50: (–18;3: vs –9;5:, p<0.01).
A strong correlation was observed between
EF and GS with good reproducibility.
Stephanie BretteAutomated Function Imaging (AFI)- A New Onboard and Clinically Applicable
Method of LV Global Function Assessment by Speckle Tracking. Circulation. 2006;114:II_364
Regional systolic function
Regional systolic function
LV diastolic function
LV diastolic function
Valsalva maneuver
Progression of Dyastolic
Dysfunction
Diastolic function algorithm
LA filling pressure and grading
diastolic dysfunction
Conclusion
 For more accurate
assessment of LV
function ( systolic,
diastolic,
longitudinal,….regional)
we have to use all
echocardiographic
modalities
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