1. Echocardiographic Assessment of LV Systolic Function
MR. MOHAMMED AL GHAMDI

2. Causes of LV Systolic Dysfunction
CAD
HTN
Cardiomyopathy (iDCM, HCM, Etoh, Peripartum, Viral, Infiltrative, Toxins, Thyroid Dz., Tachyarrythmias)
Valvular Disease

3. Dimensions and Area
Parasternal short-axis at level of papillary muscles
Parasternal long-axis
Apical 4-chamber
Apical 2-chamber

7. LV Systolic Function Variables
LVEDD – LVESD
FS = X 100
LVEDD
Percent change in LV dimension with systolic contraction
FS approximates EF if there are no significant wall motion abnormalities
SV = EDV - ESV CO = SV x HR
EDV - ESV
EF = X 100
EDV

8. How do we quantify LV function?
M-Mode
Modified Simpson’s Method
Single plane area-length method
Velocity of Circumferential Shortening
Mitral Annular Excursion
E-point to septal separation
Rate of rise of MR jet
Index of myocardial performance
Subjective assessment

9. M-Mode Quantification
Uncorrected (LVEDD)2 - (LVESD)2
LVEF = X 100
(LVEDD)2
If apical contractility is normal (Quinones group):
Corrected
LVEF = Unc LVEF + ((100 – Unc LVEF) X 15%)
5% hypokinetic, 0% akinetic, -5% dyskinetic, -10% aneurysm

11. Modified Simpson’s Method
EDV – ESV
LVEF = X
EDV

12. Normal E point to septal separation is < 6 mm
With reduced lvef, EPSS may be increased.

13. Index of Myocardial Performance
Normal LV: /- 0.05
LV, DCM: /- 0.10
Normal RV: /- 0.04
Primary Pulm HTN: /- 0.34
Use PW of AV inflow signal, or CW to get AV regurgitant signal…..Also need to measure interval between AV closure and opening (AVco).
Then, need to use PW or CW to capture semilunar outflow signal to measure ejection time (ET). After all of this, IMP can be calculated.
IMP = (AVco – ET)/ET

14. Assessment of Regional Function
Based on grading wall motion divided into the 16 (17) segment model as proposed by the American Society of Echocardiography
Each segment can be viewed in multiple tomographic planes

19. Assessment of Regional Function
1 = normal
2 = hypokinesis
3 = akinesis
4 = dyskinesis
5 = aneurysmal
WMSI = Sum of scores / Number of visualized segments
WMSI > 1.7 may suggest perfusion defect > 20%

20. Assessment of Regional Function
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

25. Doppler Tissue Imaging for Wall Motion Analysis
Myocardium is color-coded according to velocity
On P-Short Axis view, normal LV anterior wall motion during systole is blue (away from transducer), and the posterior wall motion is red (toward transducer); akinesis will have no color

28. Summary
LV Mass Quantification: M-mode, Area-length method, Truncated ellipsoid method, and Subjective assessment.
LV Volume Quantification: M-mode, Subjective assessment
LV Function Quantification: Modified Simpson’s and Subjective Assessment by region………….Also by M-mode, Single plane area length method, Velocity of Circumferential Shortening, Mitral Annular Excursion, EPSS, Rate of Rise of MR jet, Index of myocardial performance, etc……..

29. Summary
Modalities limited by quality of echo windows, accurate measurements are based on the ability to identify and capture ideal axis (recognize misleading off axis/tangential slices), and of course, echocardiographer experience……..

31. CORONARY ARTERY SUPPLY
Regional wall analysis correlates well with coronary artery supply
LAD – anterior, septum
RCA – inferior, basal septum
Circumflex – lateral, posterior

32. LV SYSTOLIC FUNCTION-EYEBALL ASSESSMENT
Experienced operator
Quick and easy
Subjective