8. Case of the month: Assessment of LV function

This month I thought it might be good to review the basics of assessment of LV function.

This is a PLAX. What are the 3 ways you would assess systolic LVF in this patient?

To help you with this, compare the clip with the PLAX of a patient with normal LV function below.

  1. Look at the thickening of the myocardium during the cardiac cycle. If the myocardium thickens more than 30% by simply eye balling the myocardium then this is normal . The walls are not thickening much in our patient.

2. Look at how much smaller the LV cavity gets in systole. This can be referred to as the amount of “squeeze” the LV is capable of. The LV cavity is large in our patient and does not get much smaller in systole.

3. Look for the E point septal separation or EPSS. What is this? This is a measure of how close the anterior mitral valve leaflet gets to the interventricular septum. It correlates well with LVEF. A normal EPSS is < 7 mm. A EPSS of > 10 mm is significant for poor LV function. The E point separation is >10mm in our patient. Compare this with the EPSS of a patient with normal LV function.

By placing an M mode cursor through the LV cavity and through the tip of the mitral valve it is possible to measure this with accuracy during the cardiac cycle.

Look at this echo below.

  • How would you describe the LV function?
  • How would do you assess LV function in the PSAX view?

The LV function is normal

You are looking for

  1. Inward movement of the myocardium. Imagine a dot in the centre of the ventricle the walls are moving towards.
  2. Thickening of the myocardium. Don’t include the papillary muscle. Don’t include the RV wall. A normal myocardium thickens by approximately 30% at  end systole from end diastole.
  3. Regional wall abnormalities. This is probably the best view to look for regional wall abnormalities.

This is the 4-chamber view of a patient we saw last week in the Emergency Department.

  • How would you describe the LV function?
  • What would you be looking for to assess LV function in this view?

Compare the above with the clip below.

The 4-chamber view of the patient seen in ED shows severely reduced LV function

We are looking for 2 things to assess LV function in the 4-chamber view

  1. Radial contraction ie thickening of the myocardium
  2. Longitudinal contraction which can be assessed by looking at the movement of the anterior mitral valve annulus towards the apex in systole. If it is not moving much then there is poor LV contraction

With a little bit of practice assessment of LV function will become second nature so keep scanning!



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