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Echocardiography 5 minutes before startingThursday, April 24, 2014 - 00 :30

Overview

[Echocardiographic examinations] [Cardiac function and PA-pressure]

[Systolic LV function][Diastolic LV function][Longitudinal function][RV function][PA-pressure]

[Examples of pathological findings]

Systolic LV function

[Regional wall motion] [17-segment model] [Examples]

Assessment and description of left ventricular function comprises usually its systolic or diastolic, global or regional aspects.Myocardial function during the whole cardiac cycle is more complex, due to myocardial architecture. Radial left ventricularfunction predominates certainly, but longitudinal and torsional function also play a role. Global strain (e.g. 2D-strain), as wellas other parameters, can give an insight in the longitudinal left ventricular function. Radial LV function can be assessed withthe methods presented below.

Qualitative assessment of systolic LV function

multiple cross-sectional views

endocardial movement and myocardial thinckening

Assessment: "descriptive" | Ejection fraction, %*

normal | 55 %mild impairment | 45 - 54 %moderate impairment | 30 - 44 %severe impairment | < 30 %

*Current reference limits after the new recommendations of American Society of Echocardiography

(ASE), 2005.

Quantitative assessment of systolic LV function

Calculation of left ventricular ejection fraction, LV-EF

Formula: [(EDV - ESV) / EDV] x 100 = EF (%)

Assessment of LV volumina with the method of discs (modified Simpson's rule, biplane)

Regional wall motion assessment

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17-segment model: left ventricular wall segments

There are several models to depict left ventricular wall segments, and correspondingly, some confusion. The 16-segmentmodel, suggested by the American Society of Echocardiography in 1989 has proven its practicability in clinical work.

Three-chamber view, used regularly in echocardiography examinations in Europe since decades introduced two more apicalsegments: anteroseptal apical and posterior apical (18-segment model). In American models, apical segments remained only4: apical anterior, apical lateral, apical inferior and apical septal.

A new model was recently proposed, in order to equalize standards in echocardiographic, thallium-scintigraphy, NMR and PETexaminations. The document can be downloaded directly from the ASE: Recommendations for C hamber Quantification, 2005.

The typical distribution of coronary perfusion and the new 17-segment model from the ASE shown here. Segmentaldenomination has change since 2005: there are no more posterior segments, also no pure septal or lateral segments, butanterior and inferior segments (anteroseptal, anterior and anterolateral, as well as inferoseptal, inferior and inferolateral).

http://www.asefiles.org/ChamberQuantification.pdf

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[overview]

Examples of wall motion abnormalities

Left: normokinesia of all wallsegments in four-chamber view.Notice the slight lesser movementof septal compared to lateralsegments. This is a physiologicalphenomenon.

Right: lateral hypokinesia. A lightincrease of wall thinkness duringsystole can still be seen. Notice theclear septal hyperdynamia as acompensatory reaction.

Left: inferior basal akynesia,inferior medial hypokinesia in thetwo-chamber view. Notice the

absence of myocardial thickeningin the akinetic segment.

Right: dyskinesia of the LV apex.Notice die excentric movement ofthe corresponding LV segmentsduring the systole.

Left:mild impairment of the sys-tolic left ventricular function withhypokinesia inferoseptal.

Right: akinesia anterolateral andhypokinesia inferoseptal.

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Left: dyskinesia inferobasal withformation of an aneurysm.

Right: dilated cardiomyopathywith severe impairment of thesystolic left ventricular function.

Left:3D volumetry of the left ven-tricle. Offline reconstruction in a

case with normal LV function. 3DEF is here 73%.

Right: 3D EF of 38% here in acase with anterior wall infarctionwith formation of an aneurysm.These examples were friendlyprovided by Dr. med. Sebastian

Buss.

[overview]

http://www.klinikum.uni-heidelberg.de/Dr-med-Sebastian-J-Buss.113787.0.html?&FS=&L=

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