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
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