Left and Right Systolic Dysfunction

Left and Right Systolic Ventricular Dysfunction

Anderson Ch. 2 Ventricular Systolic Function

Index

1. Learning Objectives

8. Section 2 - RV systolic dysfunction

2. Ranges for systolic function evaluation

9. Tools of the trade RV function

10. Evaluation of data for RV function

3. LV RWMA Assessment

4. Stress echo interpretation

11. Comparison

5. Visual estimation of LVEF

12. Post-operative dyssyrnergic septum

13. RWMA RV

6. Agree or disagree the calculated LVEF

14. Thanks

7. U of A Video on LVEF assessment at the bedside

Learning Objectives

• Identify clinical indications for systolic evaluation
• Identify the ranges of LV function (Hyperkinetic, normal, mild, moderate, severe)
• Assess echocardiogram views and data for LV systolic dysfunction
• Assess echocardiogram views and data for RV systolic dysfunction

LV Systolic Dysfunction

Indications for Systolic Function Evaluation

• Most common setting to evaluate for systolic function is suspected heart failure
• Ischemic heart disease
• Acute chest pain with suspected MI and nondiagnostic ECG
• Device evaluation (pacemaker or internal cardiac defribillator ICD)
• Initial evaluation of known or suspected cardiomyopathy (i.e. restrictive, infiltrative, dilated, hypertrophic, or genetic)
• Interventions in regurgitant valve lesions

Ranges of Left Ventricular Systolic Function When Assessing the Ejection Fraction

• Know the categories of LV EF (%) for both females and males
• Only the normal range and mildy abnormal ranges differ between males and females

The following slides are interactive where you will decide how to interpret whether the image or cine-loops are normal or abnormal.

We will work together next class to review the following slides.

Which image shows normal LV systolic function and which image shows LV systolic dysfunction?

Drag the correct description on top of the video.

Normal LV function

Abnormal LV function

Normal LV function

Abnormal LV function

Remember to right click on the YouTube video and select loop, so that the cine-loop can continuously play when comparing studies.

RWMA Assessment

Match the correct description to the myocardial wall segment by dragging the description to the yellow point

Data 1

Akinetic

Hypokinetic

Hypokinetic

Normal

Akinetic

Normal

Note : Lines on the inferoseptal and anterolateral walls imply the basal and mid segments

What would you expect the left ventricular ejection fraction to be based on this single cine-loop?

• > 65 %

• 55-65 %

• < 45 %

• 45-55 %

Dobutamine Stress Echo Interpretation

PLAX of a dobutamine stress echocardiogram with simultaneous displays of the LV before dobutamine (upper left), with low-dose dobutamine (upper right), with peak-dose dobutamine (lower left), and after dobutamine (lower left)

Determine if there are any resting WMA's and if there are inducible ischemic abnormalites during low and high doses of dobutamine

Determine if the following view has a normal LVEF or a decreased LVEF.

Are there any regional wall motion abnormalities?

Match the description to the corresponding cine-loop

Hyperdynamic LV function

Normal LV function

Severely reduced LV function

Mildy reduced LV function

Moderately reduced LV function

Determine if there is normal or abnormal LV function for each image

Answers will be revealed in class. Please try these on your own.

Watch the following cases and determine if you agree with the sonographer's calculation of the left ventricular ejection fraction

Patient with atrial fibrillation - Try to visually estimate the LVEF before the end of the video!

There may be a regional wall motion abnormality in this case - Try to visually estimate the LVEF before the end of the video!

Here is a video from the University of Alberta on some tips when visually evaluating LV function at the bedside i.e. ICU, CCU and ER

RV Systolic Dysfunction

Tools of the Trade to Evaluate RV Function (Most commonly used)

• Tricuspid annular plane systolic excursion (TAPSE)

• RV fractional area change

• Tissue Doppler peak systolic velocity tricuspid annulus

• RV longitudinal strain

• 3D RVEF

Click on each tool if you don't remember what each tool is and looks like in clinical practice.

Evaluate right ventricular longitudinal function in this image

Click on the correct answer to advance to the next slide.

Is it normal?

Is it abnormal?

Hover over the image with your mouse to zoom in on the image!

In the following images determine whether there is normal or abnormal RV systolic function. Drag the appropriate description under the image.

Abnormal RV systolic function

Normal RV systolic function

Abnormal RV systolic function

Normal RV systolic function

Abnormal RV systolic function

Normal RV systolic function

Post-operative Dyssynergic Septum

In conditions such as postoperative cardiac surgery, the right ventricular ejection fraction may not reliably represent true right ventricular (RV) contractility, as much of the RV work is done by the markedly dyssynergic septum.

Determine which cine-loop demonstrates either normal or abnormal RV function.

Normal

Abnormal

Normal

Abnormal

Evaluate the RV Systolic Function

Severely depressed RV function

Mildly depressed RV function

Severely depressed RV function

Normal RV function

Moderately depressed RV function

Moderately depressed RV function

Find the regional wall motion abnormalities in the right ventricle

Visually estimate the RV function and determine if there are any regional wall motion abnormalities

Or is it?

A very helpful video on RV Heart Strain

Thanks!