Echobasics [start] [author] [print] [impressum]

Echocardiography 5 minutes before starting  


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 ventricular function predominates certainly, but longitudinal and torsional function also play a role. Global strain (e.g. 2D-strain), as well as other parameters, can give an insight in the longitudinal left ventricular function. Radial LV function can be assessed with the 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





17-segment model: left ventricular wall segments

There are several models to depict left ventricular wall segments, and correspondingly, some confusion. The 16-segment model, 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 apical segments: anteroseptal apical and posterior apical (18-segment model). In American models, apical segments remained only 4: 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 PET examinations. The document can be downloaded directly from the ASE: Recommendations for Chamber Quantification, 2005.

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







[overview]




Examples of wall motion abnormalities

Left: normokinesia of all wall segments in four-chamber view. Notice the slight lesser movement of septal compared to lateral segments. This is a physiological phenomenon.

Right: lateral hypokinesia. A light increase of wall thinkness during systole can still be seen. Notice the clear septal hyperdynamia as a compensatory reaction.

Left: inferior basal akynesia, inferior medial hypokinesia in the two-chamber view. Notice the absence of myocardial thickening in the akinetic segment.

Right: dyskinesia of the LV apex. Notice die excentric movement of the corresponding LV segments during the systole.

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

Right: akinesia anterolateral and hypokinesia inferoseptal.

Left: dyskinesia inferobasal with formation of an aneurysm.

Right: dilated cardiomyopathy with severe impairment of the systolic left ventricular function.

Left: 3D volumetry of the left ven- tricle. Offline reconstruction in a case with normal LV function. 3D EF is here 73%.

Right: 3D EF of 38% here in a case with anterior wall infarction with formation of an aneurysm. These examples were friendly provided by Dr. med. Sebastian Buss.



[overview]