Download quantification of the left ventricular function by different methods

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