Echo LV function Assessment

Echo LV function Assessment Alfred Mureko UCT 23/03/12 LV function 1.Systolic function 2.Diastolic function Multiple

parameters LV systolic function Major prognostic factor in cardiac disease Systematic study through Mmode,2D and doppler flow Investigation

Allows assessment of global and regional LV systolic function Change in LV geometry between systole and diastole LV systolic function Parameters in systolic function

Change in diameter Change in area Change

in volume Change in diameter Fraction shortening-FS M-mode analysis or 2D LVEDD: 3.5-5.6 cm LVESD: 2-4 cm FS=(LVEDD-LVESD)/LVEDD

*100 Normal:26-45% Fraction shortening(FS) Limitations LV must contract uniformally to reflect global LV functioning Caution

in conditions that can change cardiac geometry : segmentally diseased LV dilated RV LBBB Change in Fractional Area 2D

echo measurement, EDA,ESA EDA-ESA/EDA *100 Normal: greater than 45% Also affected by conditions affecting cardiac geometry Change in volume-EF EF:

well accepted useful index of LVF Interaction: preload,afterload and contractility in determining LV fx Not a measure of contractility but crude indicator of systolic fx EF=EDV-ESV/EDV *100 Normal EF:50-80%

Methods of EF calculation Area-length method Simpsons Rule eye ball SV:SV=Flow velocity integral *AVA

Normal:70-140ml/beat EF in AS Severity:PG,AVA,flow velocities PG is a reliable indicator of AS severity only with good LV function PG will fall as the LV fx deteriorates in end-stage disease

AVA is less flow dependant than PG Dobutamine stress echo Truly severe AS vs Aortic pseudostenosis EF in MR LVEF EF is always overestimated

more than 60% is normal LVID(FS) is a better indicator of LV function Systolic function

Regional wall motion LV segmental analysis Apical/mid/basal Hypokinesis,akinesis,dyskinesis,n ormal WMSI as powerful as EF in prognosticating patients after MI. Systolic function Tissue doppler assessment

Tissue velocity and not blood velocity Systolic velocity from MV annulus Good index of global LV function Velocity>8cm/s: good EF Velocity<3cm/s: poor EF Other Parameters in systolic fx LV

wall thickness:6-12mm >12mm-LVH,independant prognostic indicator in CVS disease Amplitude of IVS indicator of LV fx

Diastolic function Ability LV of the LV to accommodate blood wall relaxation, filling, compliance Normal

LV-EF in CCF should spark suspicion about possible diastolic failure Generally worsens with age: reversed E:A Parameters in Diastolic function Trans-mitral velocities

PWD Pulmonary veins Tissue Doppler Investigation Trans-mitral velocities Transmitral velocities E:A ratio: 0.75-1.5 DT: 140-220ms Diastolic dysfunction: reversal of E:A ratio, pseudonormalisation

short/prolonged DT DT:shortened by high LVEDP prolonged by impaired LV relaxation Trans-mitral velocities Pulmonary vein PWD Pulmonary veins PWD S-wave: antegrade LA inflow

blunted in poor LV relaxation D-wave: antegrade LA inflow Ar-wave: retrograde flow into PV augmented in poor LV compliance Grading of diastolic dysfx Normal

diastolic fx(normal e:a) Impaired relaxation(e:a reversal) Pseudonormalisation(e:a appears

normal) Restrictive filling(e:a more than 2) Hallmark of diastolic dysfx Reversal of E:A Prolonged DT Augmented Ar-wave on PV PWD

THE END... I miss the days when apples and blackberries were just fruits...