Systolic Function

The Left Ventricle

Each echocardiogram should include an evaluation of the LV dimensions, wall thicknesses and function.

Several (read: different) measurements have to be performed from different views to asses a good estimate of LV function.

Left ventricular systolic function

Left ventricular function

	Women				Men
	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal
Linear method
Wallmotion score index	1.0	1.0-1.5	1.5-2.0	<2.0	1.0	1.0-1.5	1.5-2.0	<2.0
Endocardial fractional shortening, %	27-45	22-26	17-21	≤16	25-43	20-24	15-19	≤14
Midwall fractional shortening, %	15-23	13-14	11-12	≤10	14-22	12-13	10-11	≤10
2D Method
Ejection fraction, %	≥55	45–54	30–44	<30	≥55	45–54	30–44	<30
Doppler Method
Myocard performance index	<0.40				<0.40
dP/dt	>1100			<500	>1100			<500
Bold values: Recommended and best validated.[1] Click here for ejection fraction determination by Teichholz 'formula Click here for calculating dP/dt Click here for calculation myocardial performance index Click here to calculate fractional shortening.

Left ventricular function by Strain Rate Imaging

Comparison of segmental Values (mean and SD) for LV strain (TQ<3), with a repeated measures design.[2]
	All Levels	Apical	Mid	Basal	pValue (Levels)
All Walls	-18.6±5.1	-20.2±5.6	-18.7±3.3	-17.0±5.2	<0.0001
Anterior	-19.5±4.2	-19.4±5.4	-18.8±3.4	-20.1±4.0	0.001
Anteroseptal	-18.8±4.2	-18.8±5.9	-19.4±3.2	-18.3±3.5	0.001
Inferior	-20.0±4.5*	-22.5±4.5	-20.4±3.5	-17.1±3.9	<0.0001
Lateral	-18.3±4.7	-19.2±5.4	-18.1±3.5	-17.3±5.0	0.06
Posterior	-16.3±6.3†	-17.7±6.0	-16.8±5.0	-14.5±7.4	<0.0001
Septal	-18.3±5.3	-22.3±4.8	-18.7±3.0	-13.7±4.0	<0.0001
p (walls)	<0.0001	<0.0001	<0.0001	<0.0001
*inferior was significantly different from other walls (p<0.001 except anterior p+0.002), in the comparison of walls at all levels.†Posterior was significantly different from all other walls (p<0.0001). In the comparison oflevels in all walls, each level was significantly different (p <0.0001). LV=left ventricular, TQ=tracking quality.

References

1. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W, American Society of Echocardiography's Nomenclature and Standards Committee, Task Force on Chamber Quantification, American College of Cardiology Echocardiography Committee, American Heart Association, and European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006 Mar;7(2):79-108. DOI:10.1016/j.euje.2005.12.014 |
2. Marwick TH, Leano RL, Brown J, Sun JP, Hoffmann R, Lysyansky P, Becker M, and Thomas JD. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range. JACC Cardiovasc Imaging. 2009 Jan;2(1):80-4. DOI:10.1016/j.jcmg.2007.12.007 |