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mid antero septum basal septal

\ I basal inferior ^apical inferior mid posterior \ j , / apical ante apical septal tiC u u

mid lateral j mid inferior basal I

inferior basal anterior

NqT^Z-mid posterior f "T^kZ-----apical septal

I V " | "J ^ apical anterior f .. \ \ apical lateral mid \ / inferior apical inferior midseptai mid anterior

(Table 2) should always be sought and the examination ECH°CARDI°GRAPfflC ASSESSMENT should be interpreted within this wider context (Table 3). OF LV SIZE

This chapter discusses echocardiography assessment of Assessment of LV size is one of the most important systolic function. components of quantitation of ventricular function.

Fig. 1. (A) A 72-yr-old man with history of coronary artery disease and heart failure. The left ventricular ejection fraction measured 15%. The apical septal and apical inferior segments were aneurysmal. The entire anterior wall, mid- and distal lateral walls, anterior septal, midposterior segment, midseptal segments, midinferior segment, and basal septal segments were akinetic. The basal lateral and basal inferior segments were hypokinetic. The basal inferior segment contracts and thicken normally. Right ventricular size was not enlarged and right ventricular systolic function was preserved. (B) Computerized record of regional wall motion scores. Computerized record of left ventricular wall motion of patient in A with wall motion score index (WI) of 3.1 (normal = 1) (please see C). (C) Left ventricular segmental nomenclature. Left ventricular segmental nomenclature according to the American Heart Association/American Society of Echocardiography recommendations (see Fig. 10A,B). (D) Left ventricular volumes calculated by the biplane method of discs. The recommended method of quantifying left ventricular ejection fraction employs volumetric calculations using two orthogonal biplanes according to the method of discs, (see Fig. 14). (Please see companion DVD for corresponding video.)

Fig. 1. (A) A 72-yr-old man with history of coronary artery disease and heart failure. The left ventricular ejection fraction measured 15%. The apical septal and apical inferior segments were aneurysmal. The entire anterior wall, mid- and distal lateral walls, anterior septal, midposterior segment, midseptal segments, midinferior segment, and basal septal segments were akinetic. The basal lateral and basal inferior segments were hypokinetic. The basal inferior segment contracts and thicken normally. Right ventricular size was not enlarged and right ventricular systolic function was preserved. (B) Computerized record of regional wall motion scores. Computerized record of left ventricular wall motion of patient in A with wall motion score index (WI) of 3.1 (normal = 1) (please see C). (C) Left ventricular segmental nomenclature. Left ventricular segmental nomenclature according to the American Heart Association/American Society of Echocardiography recommendations (see Fig. 10A,B). (D) Left ventricular volumes calculated by the biplane method of discs. The recommended method of quantifying left ventricular ejection fraction employs volumetric calculations using two orthogonal biplanes according to the method of discs, (see Fig. 14). (Please see companion DVD for corresponding video.)

Echocardiography Heart Failure
Fig. 2. The role of echocardiography in heart failure.

Qualitative and quantitative data derived from echocardiography, e.g., LV dimensions and wall thickness, can influence patient management and serve as potent predictors of outcomes (Table 4). In patients with chronic stable coronary artery disease, there is a consistent relationship between heart size and outcomes. As heart size increases, so does mortality. The same applies to patients without heart failure. Data from the Framingham Heart Study showed that even in patients without a history of heart failure or myocardial infarction, LV size (by M-mode echocardiography) was an important predictor of subsequent risk of heart failure.

Table 1

Common Underlying Causes of Ventricular Dysfunction

• Ischemic heart disease (~75% in industrialized countries)

• Cardiomyopathies

• Pressure overload states

Hypertensive heart disease Valvular heart disease: aortic stenosis

• Volume overload states

Valvular heart disease: aortic incompetence, mitral regurgitation

Ventricular septal defect

• Rapid ventricular rate states

Sustained ventricular tachycardias (e.g., atrial fibrillation with rapid ventricular response)

• Congenital heart disease lv dimensions by m-mode

The oldest and still widely used method for linear measurements of LV size is M-mode echocardiography. It is simple, reproducible, accurate (when properly applied), and provides excellent endocardial border definition (owing to high frame rate). The American Society of Echocardiography (ASE) recommends measurement of LV dimensions with the M-mode line perpendicular to

Table 2

Common Precipitants of Heart Failure

• Therapeutic noncompliance

• Arrhythmias

• Acute ischemia, including myocardial infarction

• Systemic or cardiac infection, e.g., myocarditis

• Physical, environmental, and emotional stress

• Pulmonary embolism

• High output states, e.g., anemia, thyrotoxicosis, pregnancy

• Drugs and toxins, including nonsteroidal anti-inflammatory drugs, ethanol

Table 3

Pathophysiological Mechanisms in Heart Failure

Table 3

Pathophysiological Mechanisms in Heart Failure

Structural

Cellular/cardiac myocyte abnormalities:

abnormalities

necrosis, fibrosis, hypertrophy,

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