Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Regional Left Ventricular Systolic Function


Given its considerable diagnostic, prognostic, and therapeutic implications, the assessment of left ventricular (LV) regional systolic function forms an important part of any echocardiographic examination. Because coronary artery disease (CAD) is by far the commonest cause resulting in regional LV systolic dysfunction, the mere presence of regional wall motion abnormality (RWMA) usually confirms the presence of underlying CAD. Additionally, the distribution of RWMA helps in predicting the location of stenosis in the coronary arterial tree, whereas the extent of RWMA and its potential reversibility help in guiding several therapeutic decisions in these patients.

Assessment of Regional LV Systolic Dysfunction

Numerous qualitative, semiquantitative, and quantitative methods have been developed over the years to evaluate LV regional systolic function ( Table 25.1 ). All of these techniques rely on a segmental approach that divides LV myocardium into a number of segments and the contractile function of each segment is then assessed individually.

TABLE 25.1
Methods for Assessment of Regional Left Ventricular Systolic Function
Modality Method
M-mode

  • Regional thickening

2D echocardiography

  • Visual assessment of wall motion

  • Percent radian shrinkage

  • Percent segmental area reduction or fractional area change

  • Center-line chordal shortening

  • Acoustic quantification with color kinesis

3D echocardiography

  • Regional volume change

Tissue Doppler imaging

  • Segmental velocity

  • Segmental displacement

  • Segmental strain and strain rate

Speckle-tracking echocardiography (can be 2D or 3D)

  • Segmental longitudinal, radial, and circumferential strain and strain rate

  • Layer-specific strain and strain rate

2D , Two-dimensional; 3D, three-dimensional.

Left Ventricular Myocardial Segmentation

For the purpose of standardization, the American Society of Echocardiography had recommended a 16-segment model in 1989, but a 17th segment, the apical cap, was added later to allow comparison with other imaging modalities, such as nuclear imaging ( Fig. 25.1 ). , Although either model can be used for assessment of LV systolic function by echocardiography, the 16-segment model remains clinically applicable because the apical cap normally does not exhibit any apparent contractile function. However, when the WMA is localized to the true apex, the 16-segment model may lead to overestimation of systolic dysfunction during scoring. In comparison, strain imaging software typically divide the left ventricle into 18 segments.

Figure 25.1, Schematic diagram of the different left ventricular segmentation models: 16-segment model (left) , 17-segment model (center) , and 18-segment model (right) .

Methods for Assessment of Regional Left Ventricular Systolic Function

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts