Left ventricle: systolic function

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The assessment of left ventricular (LV) systolic function is one of the most important parts of correct diagnosis, selection of treatment strategy or medications, and prediction of prognosis. Although cardiac magnetic resonance imaging is generally accepted as the gold standard in vivo imaging modality for assessing LV systolic function, its practical use is limited due to its limited availability, high cost, and the presence of conditions precluding its performance such as a pacemaker, claustrophobia, and severe arrhythmia. Thus, transthoracic echocardiography is a first-line imaging modality employed in daily practice and has been widely used. Since the first attempts with M-mode approach, remarkable improvements have been made with the advent of two-dimensional echocardiography, and more recently three-dimensional echocardiography, with high accuracy and reproducibility. More sophisticated methodologies such as strain imaging, based on Doppler or speckle tracking techniques, provide a more sensitive and quantitative measurement of myocardial contractility, and are gaining a place in common daily practice. This chapter describes different modalities that have been used for assessment of LV systolic function based on echocardiography, and is grossly composed of two parts: LV global systolic function and LV regional or segmental systolic function. For better application of these conventional and novel methods of assessing LV systolic function, strengths and pitfalls of these techniques should be acknowledged.