7LV Systolic Function Variables LVEDD – LVESDFS = X 100LVEDDPercent change in LV dimension with systolic contractionFS approximates EF if there are no significant wall motion abnormalitiesSV = EDV - ESV CO = SV x HREDV - ESVEF = X 100EDV
8How do we quantify LV function? M-ModeModified Simpson’s MethodSingle plane area-length methodVelocity of Circumferential ShorteningMitral Annular ExcursionE-point to septal separationRate of rise of MR jetIndex of myocardial performanceSubjective assessment
9M-Mode Quantification Uncorrected (LVEDD)2 - (LVESD)2LVEF = X 100(LVEDD)2If apical contractility is normal (Quinones group):CorrectedLVEF = Unc LVEF + ((100 – Unc LVEF) X 15%)5% hypokinetic, 0% akinetic, -5% dyskinetic, -10% aneurysm
12Normal E point to septal separation is < 6 mm With reduced lvef, EPSS may be increased.
13Index of Myocardial Performance Normal LV: /- 0.05LV, DCM: /- 0.10Normal RV: /- 0.04Primary Pulm HTN: /- 0.34Use 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
14Assessment of Regional Function Based on grading wall motion divided into the 16 (17) segment model as proposed by the American Society of EchocardiographyEach segment can be viewed in multiple tomographic planes
19Assessment of Regional Function 1 = normal2 = hypokinesis3 = akinesis4 = dyskinesis5 = aneurysmalWMSI = Sum of scores / Number of visualized segmentsWMSI > 1.7 may suggest perfusion defect > 20%
20Assessment of Regional Function Qualitative estimation errors due to:Underestimation of EF due to endocardial echo dropoutand seeing mostly epicardial motionUnderestimation of EF with enlarged LV cavity; a largeLV can eject more blood with less endocardial motionOverestimation of EF with a small LV cavitySignificant segmental wall motion abnormalities
25Doppler Tissue Imaging for Wall Motion Analysis Myocardium is color-coded according to velocityOn 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
28SummaryLV Mass Quantification: M-mode, Area-length method, Truncated ellipsoid method, and Subjective assessment.LV Volume Quantification: M-mode, Subjective assessmentLV 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……..
29SummaryModalities 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……..