Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Echocardiographic Assessment of LV Systolic Function MR. MOHAMMED AL GHAMDI MR. MOHAMMED AL GHAMDI."— Presentation transcript:

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

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

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

4

5

6

7 LV Systolic Function Variables LVEDD – LVESD LVEDD – LVESD FS = X 100 FS = X 100 LVEDD 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 SV = EDV - ESV CO = SV x HR EDV - ESV EDV - ESV EF = X 100 EF = X 100 EDV EDV

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

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

10

11 Modified Simpson’s Method EDV – ESV EDV – ESV LVEF = X 100 LVEF = X 100 EDV 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: / Normal LV: / LV, DCM: / LV, DCM: / Normal RV: / Normal RV: / Primary Pulm HTN: / Primary Pulm HTN: / Use PW of AV inflow signal, or CW to get AV regurgitant signal…..Also need to measure interval between AV closure and opening (AVco). 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. 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 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 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 Each segment can be viewed in multiple tomographic planes

15

16

17

18

19 Assessment of Regional Function 1 = normal 1 = normal 2 = hypokinesis 2 = hypokinesis 3 = akinesis 3 = akinesis 4 = dyskinesis 4 = dyskinesis 5 = aneurysmal 5 = aneurysmal WMSI = Sum of scores / Number of visualized segments WMSI = Sum of scores / Number of visualized segments WMSI > 1.7 may suggest perfusion defect > 20% 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 Underestimation of EF due to endocardial echo dropout and seeing mostly epicardial motion and seeing mostly epicardial motion Underestimation of EF with enlarged LV cavity; a large Underestimation of EF with enlarged LV cavity; a large LV can eject more blood with less endocardial motion LV can eject more blood with less endocardial motion Overestimation of EF with a small LV cavity Overestimation of EF with a small LV cavity Significant segmental wall motion abnormalities Significant segmental wall motion abnormalities

21

22

23

24

25 Doppler Tissue Imaging for Wall Motion Analysis Myocardium is color-coded according to velocity 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 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

26

27

28 Summary LV Mass Quantification: M-mode, Area-length method, Truncated ellipsoid method, and Subjective assessment. LV Mass Quantification: M-mode, Area-length method, Truncated ellipsoid method, and Subjective assessment. LV Volume Quantification: M-mode, 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…….. 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…….. 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……..

30

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

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

33

34

35

36

37

38

39

40

41

42

43


Download ppt "Echocardiographic Assessment of LV Systolic Function MR. MOHAMMED AL GHAMDI MR. MOHAMMED AL GHAMDI."

Similar presentations


Ads by Google