Echocardiographic

evaluation of left
ventricular systolic function
By Dr. Sruthi Meenaxshi MD, PDF
 Assessment of left ventricular (LV) systolic function is important
for diagnosis, management, follow-up, and prognostic evaluation
of patients in a variety of clinical settings
INDICATIONS

 Signs and symptoms of heart disease.

 Signs or symptoms suggestive of heart disease such as
unexplained electrocardiographic abnormality, palpitations,
stroke, or peripheral embolic event.
 Signs or symptoms of heart failure (HF).
 Information on LV systolic function as well as diastolic function
 chamber geometry
 regional wall motion
 valve function is important for diagnosis and management

 Among patients with HF, left ventricular ejection fraction (LVEF) Is used to
identify categories of HF with preserved ejection fraction (HFpEF; LVEF ≥50
percent), HF with reduced ejection fraction (HFrEF; LVEF ≤40 percent)
 Signs or symptoms of coronary artery disease. Assessment of
regional and global LV systolic function is commonly combined
with stress testing.
•The presence of ventricular arrhythmias is a common indication for
evaluation of LV function and structure as part of an evaluation to
determine whether there is a structural cause for the arrhythmia.
DSE showing biphasic response
 Planned or prior exposure to potentially cardiotoxic therapy.
 Patients undergoing treatment with potentially cardiotoxic
therapy require serial evaluation of LV systolic function for early
detection of cardiotoxicity
 Transthoracic echocardiography (TTE) is the most commonly
preferred initial imaging modality to assess LV systolic function.
Normal LV systolic function
 Patients who require serial evaluations of LV systolic function
(eg, patients undergoing potentially cardiotoxic chemotherapy)
volumetric (3D) methods are preferred for serial evaluation and
detection of small changes .
 The use of harmonic imaging and echocardiographic contrast
media have been shown to significantly improve image quality
for assessment of LV systolic functional parameters, particularly
in patients with poor acoustic windows 
LV Dimensions by M mode

 The ASE recommends measurement of LV dimensions with

Mmode line perpendicular to long axis of the heart immediately
distal to tips of Mitral valve leaflets in parasternal long axis view
M mode assessment of LV systolic
function
E point septal separation(EPSS)
Mitral Annular plane systolic
excursion(MAPSE)
M mode through aortic valve in
patient with reduced cardiac function
Assessment of LV volume

 Several methods have been proposed for the quantitative

assessment of LVEF.
 The biplane method of discs (modified Simpson method) using
area tracings of the LV cavity is the preferred 2D method for LV
volume quantification and measurement of LVEF
 Regional evaluation of LV function is commonly determined
based on qualitative visual assessment of wall thickening and
endocardial motion of each myocardial segment visualized in
multiple views.

 Seventeen- or 16-segment models of the heart are recommended

17 segment model
 ASE guidelines recommends the 16-segment model for routine
assessment of wall motion due to limited endocardial excursion and
thickening at the tip of the apex

 ASE guidelines also recommend use of a semiquantitative wall motion

score
 1-normal or hyperkinetic
 2-hypokinetic [reduced thickening],
 3-akinetic [absent or negligible thickening], and
 4-dyskinetic [systolic thinning or stretching]) assigned to each segment
for calculation of LV wall motion score index as the average of scores
of all visualized segments
 Newer echocardiographic techniques using tissue Doppler imaging and
speckle tracking echocardiography can directly obtain information on
myocardial contractility, including myocardial velocities, strain, and strain
rate.

 These methods allow for assessment of the various components of

contraction, including radial, longitudinal, and circumferential contraction,
allowing for assessment of global and regional systolic function

 Parameters such as global longitudinal strain may prove to be more

sensitive for detection of decreased LV function than traditional measures
of LVEF , and have been recommended as an alternative clinical technique
that offers incremental prognostic information over LVEF