Final Feigenbaum’s Echocardiography DIGITAL

Chapter 5 Evaluation of Systolic Function of the Left Ventricle

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Chapter 5 Evaluation of Systolic Function of the Left Ventricle

Evaluation of Systolic Function of the Left Ventricle

FIGURE 5.27. Graphic demonstration of angular rotation extracted from a normal patient in the upper panels and a patient with left ventricular hypertrophy (LVH) and reduced left ventricular ejection fraction (LVEF) in the lower panels. The left-hand panels are recorded at the apex and the right-hand panels at the base of the left ventricle. In the normal patient, note the positive 16.7-degree rotation at the apex and the –5.4-degree rotation at the base resulting in a total twist of 22.1 degrees and torsion of 2.6 degrees/cm compared to reduced values in the patient with reduced left ventricular function.

myocardial ischemia or infarction and their detection remains the mainstay of diagnosis of ischemic syndromes. ere is regional and temporal heterogeneity of this motion, with the proximal infero- posterior and lateral walls contracting slightly later than the septum and anterior walls. ere is also normal heterogeneity of the degree of endocardial excursion and myocardial thickening, with greater absolute and percentage changes from diastole to systole at the base when compared with the apex. Most commonly, abnormal regional wall motion is the result of coronary artery disease which interrupts perfusion to fairly well- de ned territories and hence results in abnormal motion in those segments. ere is a gradation of wall motion abnormality that con- sists progressively of hypokinesis, akinesis, and subsequently dyski- nesis in which a wall moves away from the center of the ventricle. Because wall thickening and endocardial motion are intrinsically tied,

the le ventricle. Contraction results in myocardial thickening and excursion of the endocardium toward the center of the ventricle. Simultaneous with this motion toward the center and cavity shrink- age is a twisting or wringing motion of the le ventricle. When viewed from the apex, there is initially a slight clockwise rotation of the entire heart a er which the base of the le ventricle continues to rotate in a clockwise fashion and the apex rotates in a counterclock- wise fashion. is systolic wringing motion of the le ventricle is an intrinsic component to myocardial contractility and eciency. In diastole, the twisting motion of the heart is reversed and the early untwisting is largely responsible for early diastolic suction. Using M-mode or standard two-or three-dimensional echo- cardiography, only myocardial thickening and endocardial motion toward the center of the ventricle are appreciated. Abnormalities of thickening and endocardial motion are reliable indicators of

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