Chapter 15 - Left Ventricular Function

Abstract

Prompt and accurate assessment of left ventricular (LV) function is a fundamental point-of-care ultrasound (POCUS) application of paramount clinical importance to clinicians across medical and surgical specialties. Rapid qualitative assessment of LV systolic function empowers clinicians to efficiently identify LV pathology and deduce shock states and volume status to guide real-time treatment decisions, including fluid management and administration of vasoactive agents. Existing literature has consistently demonstrated that brief, focused cardiac ultrasound training is sufficient for clinicians to reliably describe qualitative LV systolic function. LV systolic function is qualitatively categorized as hyperdynamic, normal, reduced, or severely reduced by assessing endocardial excursion, myocardial thickening, and septal motion of the anterior leaflet tip of the mitral valve (E-point septal separation). More advanced assessment of LV function, including segmental wall motion abnormalities, diastology, and advanced hemodynamic measurements generally require additional training and extend beyond the scope of a basic LV assessment. This chapter reviews an organized approach to qualitatively assess LV systolic function from four standard transthoracic echocardiographic views (parasternal long-axis, parasternal short-axis, subcostal four-chamber and apical four-chamber views).