Estimation of global left ventricular function from the velocity of longitudinal shortening.

Abstract

To determine if global ventricular function can be assessed from the long-axis contraction of the left ventricle, we compared pulsed-wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. We studied 51 patients (56 +/- 10 years, 11 women) with a radionuclide ejection fraction of 52 +/- 13% (15%-70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P < 0.001), as did the time-velocity integrals (0.57 and 0.58, respectively; P < 0.001). Correlations were higher in normal ventricles (0.62-0.69) than in patients with previous myocardial infarction (0.39-0.64). Patients with anterior myocardial infarction had the lowest correlations (0.39-0.46). The best differentiation of normal (> or = 50%) from abnormal (< 50%) ejection fraction was provided by peak systolic velocity > or = 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall-motion abnormalities. However, in patients with important segmental wall-motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction.