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How to assess left ventricular function?

Non-Invasive Imaging


This educational “How To” session was dedicated to the assessment of LV function using novel techniques: speckle tracking and 3D- echo.

Jens-Uwe Voigt from Belgium, gave an excellent comprehensive overview of the principles, applications and limitations of speckle tracking in the assessment of global and regional left ventricular function, based on numerous online/live case analyses. He emphasized the importance of understanding the principles of deformation imaging to accurately calculate velocity, displacement and strain. In addition, he offered to the audience illustrative examples of the effects of different types of corrections (using a priori knowledge) on obtained signals, in order to get meaningful and accurate data set (median filtering, smoothness constraints, baseline drift compensation/correction of ECG trigger etc.). The impact of frame rate was also underlined, since the lowering of the frame rate is associated with potential missing of a significant portion of information.

Then, he discussed speckle tracking based deformation imaging in measuring true longitudinal and radial strain through numerous case examples. Also, he showed how to assess intra-ventricular asynchrony using speckle tracking. Furthermore, he showed live examples of assessing global LV function using speckle tracking, including automatic EF calculation, which offers accurate measure of LV function that could be obtained almost 2 times faster as compared to traditional 2D biplane Simpson method, with better reproducibility (lower inter-observer variability).

Finally, Professor Voigt defined global strain as a measure of global left ventricular function (average longitudinal systolic strain of one or more imaging planes). Global longitudinal speckle strain could better reflect subtle deterioration of global LV function than EF in patients on chemotherapy. It has also been shown that global longitudinal strain is a superior predictor of overall mortality than either EF or wall motion score index and has the potential to become the optimal method for assessment of global LV systolic function in patients referred to echocardiography for that purpose.

Mark Monaghan from the UK, in his presentation full of illustrative cases, elegantly showed advantages and current status of 3D-echo assessment of global and regional LV function. Using excellent examples, he showed how to obtain full volume 3D data set and how to make necessary adjustments in order to get valuable information on LV morphology and function. He stressed that 3D-echo technology is changing, the image quality is getting better than 2D and it is now possible to obtain full volume data set from the single beat. Accuracy and reproducibility of the 3D-echo assessment of chamber volumes and function are well validated against cardiac MR in multiple studies, showing lower inter- and intra-observer variability for volumes and EF, as compared to 2D-echo.

Importantly, 3D-echo measurements can significantly impact clinical decision making. After obtaining full volume data set, regional function comes ”for free” (volume curves, dyssynchrony analyses, parametric maps, contraction front mapping). Finally, in the future, more applications of 3D-echo technology should be expected in the 3D-stress echo arena, 3D-speckle tracking and fusion imaging

References


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How to assess left ventricular function?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.