Echocardiographic Assessment of the Left Ventricle

Transcription

1 Echocardiographic Assessment of the Left Ventricle Theodora Zaglavara, MD, PhD, BSCI/BSCCT Department of Cardiovascular Imaging INTERBALKAN EUROPEAN MEDICAL CENTER

2 2015 The quantification of cardiac chamber size and function is the cornerstone of cardiac imaging Echocardiography is the most commonly used noninvasive imaging modality Real-time images of the beating heart, availability, portability

3 Importance of Patient Position Steep-lateral decubitus position Raised left arm Cut-out mattress to permit visualization of the true apex while avoiding LV foreshortening Imaging at quiet respiration or end-expiration

4 Optimize Image Acquisition Before Measurements Identify end-diastole and end-systole based on MV motion and cavity size rather than reliance on ECG Average cardiac cycles in AF, avoid postectopic beats Image at minimum depth necessary Highest possible transducer frequency Frame rate 30/s, Harmonic Imaging Maximize endocardial border delineation LV chamber measurements should be reported indexed for BSA

5 Quantification of the Left Ventricle Linear Measurements

6 2D Guided Measurements Assures orientation perpenticular to LV long axis Lower frame rates Global assessment in a symmetrically contracting LV Evaluates basal regional funcion in LV with RWMA The use of linear measurements to calculate LVEF and LV volumes is not recommended in clinical practice

7 LV Volumetric Measurements: Biplane Disc Method A4C A2C Currently the recommended method is biplane method of discs (modified Simpson s rule) Total LV volume is calculated from a stack of elliptical disks Less geometrical assumptions LVEF= (EDV-ESV)/EDV Limited in cases of foreshortened apex, endocardial dropout. LV EDD: Frame after MVC- largest frame LV ESD: Frame preceding MVOsmallest frame

8 The Area Length Method An alternative method to calculate volumes when apical endocardial definition precludes accurate tracing The LV is assumed to be bullet shaped Volume= [5 (area) (length)]/6 Limited published data on normal population

9 Matrix Array Transducers: Triplane LV Imaging in one Cardiac Cycle

10 Real-time 3D Echo: Semi-automated method for LV volumes

11 3-Dimensional Assessment of LV Volume and Mass 3D echocardiography does not rely on geometric assumptions for volume/mass calculation. In patients with good image quality are accurate and reproducible. Studies comparing 3D echo LV volumes or mass with other gold standards (eg MRI) have confirmed 3D echo to be accurate. Should be used when available and feasible.

12 3 D Echo Limitations Operator experience with rendering necessary 3-D image quality greatly depends on the quality of the 2-D image and the ability to obtain a motion and artifact free 3-D data set Lower temporal resolution Necessity for regular rhythm Stiching artifacts with gated full volume acquisition Manual or automated endocardial tracing to obtain volumes can be subjected to errors Less published data on normal values

13 Endocardial Border Enhancement Helpful in patients with suboptimal acoustic window Provides higher volumes that are closer to MRI However no established normal values available at present Should be used in all patients in whom quantitative assessment of LVEF is important for prognosis or decision making. VLMI and LMI and Harmonic Imaging should be used for LVO.

14 Normal Values for LV Volumes and Dimensions in Men and Women

15 Normal Range and Severity Cut off Values for 2-D derived EF

16 2 D Strain by Speckle Tracking Longitudinal Radial ircumferencial

17 Global Longitutinal Strain (2-D)

18 Global Longitutinal Strain (4-D)

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25 LV Regional Function by Visual Assessment

26 2-D Calculation of LV Mass The area- length formula and the truncated elipsoid formula from SAX and A4C views A circular area is assumed The bi-plane Simpson s method may be used in the presence of RWMA Measurements at end diastole, papillary muscles must be excluded Reference range is up to 88 g/m²for women and up to 102 g/m² for men

27 3- Dimensional Calculation of LV Mass Measurement of LV mass by RT-3DE is obtained by subtracting the endocardial from the epicardial volume and multiplying the obtained myocardial volume by its specific weight. (1.05 g/ml)

28 Relative Wall Thickness/ LV Remodeling Increased arterial stiffness AS, hypertension, isometric exercise RWT= 2x PWT/ LVDD Chronic AR, MR, athletic heart

29 Thank you for your Attention!!