Download Left ventricular function

At the end of this session, you should
be able to:
A4Ch
 Recognise normal systolic function
HOW TO ASSESS LV FUNCTION
Stephen Glen
 Recognise severe systolic dysfunction
 Be aware of terminology used to describe
contractility
 Understand the limitations of quantitation
Bad and bad, or good and bad?
A4ch
PLAX
1
1. Good LV function
2. Bad LV function
3. Unsure
1. Good LV function
2. Bad LV function
3. Unsure
1. Good LV function
2. Bad LV function
3. Unsure
1. Good LV function
2. Bad LV function
3. Unsure
1. Good LV function
2. Bad LV function
3. Unsure
2
What measurement?
Ejection fraction
Shortening fraction
Diastolic – systolic volume
_____________________
Diastolic volume
 Qualitative (eyeball technique)
normal or
mild / moderate / severe dysfunction
 Quantitative (give a number)
Shortening fraction
Ejection fraction (biplane Simpson’s)
Wall motion scoring system
LVEDD - LVESD
Normal >60% male,
______________
55% female
LVEDD
Normal >30%
Mild 26-30%
Supporting evidence
Left ventricular territory
 Reliability of reporting left ventricular
systolic function by
echocardiography: a systematic
review
McGowan J, Cleland J. Am Heart J
2003;146:388-97
 Reviewed 43 studies
 LAD – anterior wall and apex
 LCx – posterior and lateral
 RCA – inferior wall and basal / mid septum
 95% confidence intervals calculated
for each approach:
Varies between patients – RCA may be dominant
and supply large territory, or may be tiny and supply
virtually nothing.
Simpson’s
±7 to ± 25%
(median 18%)
Wall motion ±13 to ± 20%
(median 16%)
RCA
LCA
Subjective ±16 to ± 24%
(median 19%)
3
1. Posterior infarct
2. Anterior ischaemia
3. Unsure
1. Posterior infarct
2. Anterior ischaemia
3. Unsure
Knowing the territory
81 yrs, chest pain, ST depression V1-V4
1. Anterior ischaemia
2. Posterior infarct
3. Unsure
1. Underfilled, consider IV fluids (RV infarct)
2. Not for fluid resuscitation (LV dysfunction)
3. Unsure
4
A procedure was performed..
1. Underfilled, consider IV fluids (RV infarct)
2. Not for fluid resuscitation (LV dysfunction)
3. Unsure
Mid
inferior
Mid
anterior
Describing contractility
Mid
anterior
septum
Apical
anterior
septum
Basal
anterior
septum
 Normal
 Hypokinetic (<30% thickening)
 Akinetic
Basal
inferior
Apical
posterior
 Dyskinetic
 Aneurysm
 Scar
5
PLAX, PSAX. Where is the abnormality?
1. Anterior septum
2. Posterior wall
3. Inferior wall
PLAX, PSAX. Where is the abnormality?
1. Anterior septum
2. Posterior wall
3. Inferior wall
A2Ch. Which wall is abnormal?
1. Inferior
2. Anterior
3. Unsure
A4Ch, A2 Ch
A4Ch. Where is the abnormality?
1. Septum
2. Lateral wall
3. Apex
4. Unsure
A4Ch
1. Normal LV
2. Moderate dysfunction
3. Severe dysfunction
4. Unsure
1. Normal LV
2. Moderate dysfunction
3. Severe dysfunction
4. Unsure
6
Same case. A4Ch close up
Beware the missing apex!
A4Ch
1. Normal LV function
2. Mild dsyfunction
3. Moderate dysfunction
4. Severe dysfunction
Case
A4ch
 0130 hrs
 21 yrs, footballer, GCS 4, BP 76/20
 No PMH
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