Evaluation of left ventricular systolic function and mechanics

Abstract

Analysis of left ventricular (LV) systolic function is the most frequent indication to perform echocardiography and an integral part of cardiac magnetic resonance (CMR) or radionuclide studies. Visual estimation of LV function may be supplemented by quantitative analysis of 2D images to obtain parameters of global or regional function. Administration of contrast agents to improve identification of myocardium–blood interface has been demonstrated to improve the reproducibility of 2D-echocardiography-based analysis of LV function and should be applied in cases of insufficient endocardial border definition (more than two LV segments not adequately visualized). 2D-echocardiography-based analysis of LV volumes results in underestimation of end-systolic and end-diastolic LV volumes compared to CMR. 3D-echocardiography results in significantly less volume underestimation and higher accuracy in the analysis of ejection fraction. Analysis of regional wall motion is mainly based on subjective visual assessment, which is limited by significant inter-observer variability. Doppler tissue imaging and speckle tracking echocardiography have become validated methods for quantitative analysis of regional LV function. Similarly, tagging, strain-encoded cardiac magnetic resonance (SENC) and feature tracking are modalities to quantify regional LV function based on CMR. Echocardiography should be used as a primary technique to assess systolic LV function as it is the cheapest, widely available and can be applied without the use of ionizing radiation or nephrotoxic contrast material. CMR has become the clinical gold standard for quantification of LV function and may be applied if other information achievable best by CMR is required. Similarly, nuclear techniques should be applied to assess LV function only if simultaneous assessment of myocardial perfusion is requested.