Assessment of LV Function

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Probe(s): Cardiac

Preset: Cardiac

Views:  PSL, PSS (mid-papillary level), A4C

Left Ventricular Ejection Fraction (LVEF) is the percentage of blood ejected from the LV during systole. This can be assessed using ultrasound, either qualitatively or quantitatively. The most commonly used views include the PSL, PSS at the mid-papillary level, and the A4C. 

• EF = (Diastolic volume - systolic volume)*100 / Diastolic volume

Qualitative LVEF assessment takes practice and experience. Compare your visual estimates with formal echocardiogram reports as you build your skills. The most commonly used views are the parasternal long axis and parasternal short axis. 

This approach focuses on 2 key features:

1. LV Wall Motion (Systole): Are the LV walls contracting symmetrically and coming close together during systole? 
2. Anterior Mitral Valve Leaflet Motion (Diastole): Does the anterior mitral valve leaflet approach or touch the interventricular septum during diastole? Place your finger in the centre of the ventricle and watch how the wall contracts. 

E-Point Septal Separation (EPSS) refers to the distance between the anterior mitral valve leaflet and the septum when the mitral valve has reached maximum excursion during early diastolic filling. 

• Larger EPSS distance indicates a lower ejection fraction. This aligns with the qualitative assessment of anterior mitral valve movement.

Fractional Shortening is an M-mode measurement that reflects the % change (size reduction) in left ventricular diameter between end-diastole and end-systole. 

• FS (%) = (LVEDD-LVESD)/LVEDD x 100

Fractional Area Change estimates ejection fraction in the PSS view by comparing the LV area during systole and at diastole. The normal range is approximately 35-65%.

• FAC (%) = (LVEDA-LVESA)/LVEDA x 100

Simpson (Biplane) Method) calculates ejection fraction from the LV volume during systole and diastole. It is the best measure of ejection fraction, but it is difficult, time-consuming, and the most operator-dependent technique.

• EF = (LVEDV-LVESV)/LVEDV x 100