2. Assessment of ventricular systolic function, the
essential part of all echocardiography
examinations
3. 2D echo allows visualization of the
endocardium and it’s thickening, by which
global and regional ventricular systolic
functions are assessed
Quantitative assessment of global systolic
function is usually based on changes in
ventricular size and volume
4. Fractional shortening of LV
Ejection fraction
Stroke volume and cardiac index
Systolic tissue velocity of the mitral annulus
and myocardium
Tissue tracking
Regional wall motion analysis
5. Percentage change in LV dimensions with each
LV contraction
Reflects global ventricular function
LVED - LV end-diastolic dimension
LVES - LV end-systolic dimension
6.
7. Assesses ventricular function only at the level
being interrogated
If regional dysfunction is present, which is not in the
interrogation plane, it may result in a misleading
estimate of global ventricular function
8. Expression of global LV function
Strong predictor of clinical outcome in almost
all major cardiac conditions
Determined visually by eyeballing
echocardiographic images of the LV
Considerable inter-observer variation but with
experienced readers variation is less than 5%
9. Measured quantitatively by using volumetric
measurements from M-mode, 2D and 3D
echocardiograms
LVEDV - LVESV
LVEDV
LVEF =
10.
11. EF can also calculated from LV dimensions
measured with M-mode
Measurement of LV dimensions from the mid
ventricular level is used to calculate LVEF
LVEDD2 – LVESD2
LVEDD2
Add 15% for normal, 5% for hypokinetic apex, 0% for
akinetic apex, -5% for dyskinetic apex, and -10% for
apical aneurysm
LVEF = x 100
12.
13. Not a true indicator of systolic function
Determined by multiple factors
Provides the amount of blood volume ejected
with each cardiac cycle
14. Stroke volume can be measured as the
difference between the LV end-diastolic
volume and LV end-systolic volume obtained
by the Simpson method
15.
16. The difference should be equal to SV across the
LVOT if there is no valvular regurgitation
If there is MR, regurgitant volume needs to be
subtracted to obtain stroke volume across the
LVOT
19. Cardiac output is calculated as:
CO = SV x HR
Cardiac index is calculated as:
CO
Body Surface Area (BSA)
CI =
20. Tissue Doppler imaging records the velocity of
myocardial tissue
The systolic component (S’) of the mitral
annulus correlates well with the LVEF
21.
22. Value of 8cm/s was selected as a cutoff point
Vinereanu et al. have reported (80%
sensitivity, 89% specificity) for the same cutoff
point of S’ measured at the medial mitral
annulus and (80% sensitivity, 92% specificity)
for S’ measured at the lateral mitral annulus
Estimation of global left ventricular function from the velocity of longitudinal shortening.
Echocardiography 2002;19(3):177-185
23. Systolic contraction of the ventricles is
performed optimally when regional
contractions are coordinated
All walls should contract within 20 to 30
milliseconds of each other
Disrupted by conduction delay, atrial
fibrillation, or a pacemaker
24. Assessed best with tissue Doppler imaging
Reliably provide timings of cardiac events or
myocardial movement
27. It is byproduct of tissue Doppler imaging
Basoapical views of each ventricular segment
are displayed as seven color bands, with each
color representing a particular distance the
tissue moves during systole
Tissue tracking provides a rapid assessment of
systolic motion
28. Mitral anulus displacement can be determined
instantaneously with tissue tracking
Normal mitral annular systolic motion is
>8mm (average 12 + 2 on apical 4 or apical 2
views)
A systolic mitral anulus displacement of less
than 5 mm determined by tissue tracking
correlates well with a severe decrease in the
LVEF (<30%)
29. Normal ventricular contraction consists of
simultaneous myocardial thickening and
endocardial excursion toward the center of the
ventricle
Regional contractility or wall motion of the LV is
graded by dividing the LV into segments
In 2002, a 17-segment model was recommended by
the American Society of Echocardiography
LV is divided into three levels - basal, mid or
papillary and apical
Circulation, 2002;105: 539-542
33. Numerical score is assigned to each wall
segment on the basis of its contractility as
assessed visually:
1= Normal (>40% thickening with systole)
2= Hypokinesis (10-30% thickening)
3= Severe hypokinesis to akinesis (<10% thickening)
4= Dyskinesis (out of phase)
5= Aneurysm (thinned and bulging outwards)
34. On the basis of this wall motion analysis
scheme, a wall motion score index (WMSI) is
calculated to semiquantitate the extent of
regional wall motion abnormalities
Normal WMSI is 1
WMSI > 1.7 may suggest perfusion defect > 20%
35. Qualitative estimation errors due to:
Underestimation of EF due to endocardial echo
dropout and seeing mostly epicardial motion
Underestimation of EF with enlarged LV cavity; a
large LV can eject more blood with less endocardial
motion
Overestimation of EF with a small LV cavity
Significant segmental wall motion abnormalities
37. Myocardial performance index
TEI index = IVRT + IVCT
LVET
IVCT - Isovolumic contraction time
IVRT - Isovolumic relaxation time
LVET - LV ejection time
Normal in 0.39 +/- 0.05
39. The magnitude of opening of the mitral
valve, as reflected by E-wave height, correlates
with transmitral flow and, in the absence of
significant mitral regurgitation, with left
ventricular stroke volume
Mitral valve E point (maximal early opening) is
within 6 mm of the left side of the ventricular
septum
In the presence of a decreased ejection
fraction, this distance is increased
42. If left ventricular forward stroke volume is
decreased, there may be a gradual reduction in
forward flow in late systole, which results in
gradual closing of the aortic valve in late
systole. This results in a rounded appearance of
the aortic valve in late systole