Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography

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Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography Sushil A. Luis, MBBS, Jonathan Chan, MBBS, PhD, Patricia A. Pellikka, MD Mayo Clinic Proceedings Volume 94, Issue 1, Pages 125-138 (January 2019) DOI: 10.1016/j.mayocp.2018.07.017 Copyright © 2018 Terms and Conditions

Figure 1 Left ventricle (LV) myofiber architecture. A, Myocardial fibers are arranged helically, with a gradual transition from a right-handed epicardial fiber arrangement to an orthogonal left-handed subendocardial fiber arrangement. B, Cross-sectional view of the LV wall in the short-axis plane shows the longitudinal subendocardial myofiber orientation, transverse or circumferential midmyocardial fiber orientation, and oblique subepicardial myofiber orientation. The relative ratio of circumferential midmyocardial to longitudinal subendocardial fibers should be noted. RV = right ventricle. Used with permission from Mayo Foundation for Medical Education and Research. Mayo Clinic Proceedings 2019 94, 125-138DOI: (10.1016/j.mayocp.2018.07.017) Copyright © 2018 Terms and Conditions

Figure 2 Conventional echocardiographic methods for assessing left ventricular (LV) systolic function. A, Linear LV dimensions by two-dimensional (left) and M-mode (right) methods. The yellow and white arrows indicate the LV end-diastolic diameter. B, Doppler assessment of stroke volume using the LV outflow tract dimension (left) and the velocity-time integral (right). The blue arrow indicates the LV outflow tract dimension/diameter. C, Rate of ventricular pressure rise calculated from continuous-wave Doppler of the mitral regurgitant jet. D, Modified Simpson biplane method with LV end-diastolic volume traces demonstrated in the apical 4-chamber (left) and 2-chamber (right) views. E, Microbubble contrast-enhanced echocardiographic images assessed by the modified Simpson biplane method shows LV end-diastolic (left) and LV end-systolic (right) volume traces in the apical 4-chamber view. F, Three-dimensional (3-D) volumetric assessment showing a multilevel endocardial border tracing (left) and a 3-D volume rendering (right). RV = right ventricle. Used with permission from Mayo Foundation for Medical Education and Research. Mayo Clinic Proceedings 2019 94, 125-138DOI: (10.1016/j.mayocp.2018.07.017) Copyright © 2018 Terms and Conditions

Figure 3 Assessment of 2-dimensional strain in a healthy patient. A, Parametric regional strain map in the apical long-axis view shows regional strain values superimposed on the grayscale image of anteroseptal and inferolateral segments. B, Strain curve shows synchronous change in strain, with consistent reduction in all segments. C, Color M-mode strain plot shows synchronous contraction (red central color band) of all myocardial segments represented on the y-axis, with time represented on the x-axis. D, Strain bullseye plot shows normal regional longitudinal strain in all the myocardial segments. Used with permission from Mayo Foundation for Medical Education and Research. Mayo Clinic Proceedings 2019 94, 125-138DOI: (10.1016/j.mayocp.2018.07.017) Copyright © 2018 Terms and Conditions

Figure 4 Representative peak longitudinal strain echocardiographic bullseye plots. A, An athlete with compensatory mild left ventricular dilatation and a normal strain plot. B, Cardiac amyloidosis showing severely reduced strain in the basal and midventricular segments, with preservation of the apical segments. C, Inferior myocardial infarct showing reduced strain in the right coronary artery territory. D, Hypertrophic obstructive cardiomyopathy involving the ventricular septum, with reduced strain in the corresponding basal septal and anterior segments. E, Apical hypertrophic cardiomyopathy, with reduced strain in the apical segments. F, Severe aortic stenosis with mild, nonspecific reduction in strain. Used with permission from Mayo Foundation for Medical Education and Research. Mayo Clinic Proceedings 2019 94, 125-138DOI: (10.1016/j.mayocp.2018.07.017) Copyright © 2018 Terms and Conditions

Figure 5 Serial echocardiographic peak longitudinal strain assessments in a patient with breast cancer who received trastuzumab. A, Baseline echocardiogram shows normal left ventricular strain (2-dimensional global longitudinal strain). B, Reduced global longitudinal strain with a nonspecific pattern, consistent with trastuzumab-induced cardiomyopathy. C, Partial recovery in left ventricular longitudinal strain after discontinuation of trastuzumab. Used with permission from Mayo Foundation for Medical Education and Research. Mayo Clinic Proceedings 2019 94, 125-138DOI: (10.1016/j.mayocp.2018.07.017) Copyright © 2018 Terms and Conditions