Methods for Assessment of LV Systolic Function
Methods for Assessment of LV Systolic Function
Despite its limitations, ejection fraction has become part of the lingua franca of cardiology. The evidence base for modern cardiology is so heavily based on this simple measurement that it is unlikely to disappear. The ubiquitous presence of heart failure, and its association with frailty, mandates an inexpensive, widely available test that is able to provide haemodynamic assessment—so echocardiography is likely to remain as the workhorse of LV functional assessment.
However, while the simple estimation of global function using ejection fraction is quick and sufficient for screening, it also provides suboptimal data in many situations. Subtle disturbances may need to be sought with more sophisticated and sensitive parameters such as strain. When ejection fraction is reduced, and a pivotal decision (such as device implantation or surgery) is to be based on the measurement, more accurate assessment can be obtained using either MRI or echocardiography with 3D imaging or echocardiographic contrast. When volumes are required, as in the assessment of valvular disease, 3D techniques should become mandatory. Finally follow-up studies should require a 3D strategy or geometry independent techniques such as the assessment of global strain.
For regional function, visual assessment is sufficient in many circumstances. If there is a desire to follow sequentially, or to improve sensitivity, for example, in the assessment of myocardial viability response to dobutamine, quantitative strain should be considered.
Finally, the selection of imaging techniques is sometimes driven by the measurement of comorbid conditions. Patients with valvular disease are probably still best studied with echocardiography. Where the aetiology of heart failure is sought (eg, infiltrative disorders such as amyloidosis), the selection of CMR provides the potential of tissue characterisation. Patients requiring perfusion imaging can have gross ejection fraction disturbances identified using SPECT.
Conclusions
Despite its limitations, ejection fraction has become part of the lingua franca of cardiology. The evidence base for modern cardiology is so heavily based on this simple measurement that it is unlikely to disappear. The ubiquitous presence of heart failure, and its association with frailty, mandates an inexpensive, widely available test that is able to provide haemodynamic assessment—so echocardiography is likely to remain as the workhorse of LV functional assessment.
However, while the simple estimation of global function using ejection fraction is quick and sufficient for screening, it also provides suboptimal data in many situations. Subtle disturbances may need to be sought with more sophisticated and sensitive parameters such as strain. When ejection fraction is reduced, and a pivotal decision (such as device implantation or surgery) is to be based on the measurement, more accurate assessment can be obtained using either MRI or echocardiography with 3D imaging or echocardiographic contrast. When volumes are required, as in the assessment of valvular disease, 3D techniques should become mandatory. Finally follow-up studies should require a 3D strategy or geometry independent techniques such as the assessment of global strain.
For regional function, visual assessment is sufficient in many circumstances. If there is a desire to follow sequentially, or to improve sensitivity, for example, in the assessment of myocardial viability response to dobutamine, quantitative strain should be considered.
Finally, the selection of imaging techniques is sometimes driven by the measurement of comorbid conditions. Patients with valvular disease are probably still best studied with echocardiography. Where the aetiology of heart failure is sought (eg, infiltrative disorders such as amyloidosis), the selection of CMR provides the potential of tissue characterisation. Patients requiring perfusion imaging can have gross ejection fraction disturbances identified using SPECT.
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