Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion

Abstract

Assessment of left ventricular (LV) systolic function is the cornerstone of the echocardiographic examination. There are many echocardiographic parameters that can be used for clinical and research purposes, each one with its pros and cons. The LV ejection fraction is the most used one due to its feasibility and predictability, but it also has many limits, related to both the imaging technique used for calculation and to the definition itself. LV longitudinal function is expression of subendocardial fibers contraction. Because the subendocardium is often involved early in many pathological processes, its analysis has been a fertile field for the development of sensitive parameters. Longitudinal function can be evaluated in many ways, such as M-mode echocardiography, tissue Doppler imaging, and speckle tracking echocardiography. This latter is a relatively new tool to assess LV function through measurement of myocardial strain, with a high temporal and spatial resolution and a better inter- and intra-observer reproducibility compared to Doppler strain. It is angle independent, not affected by translation cardiac movements, and can assess simultaneously the entire myocardium along all the three-dimensional geometrical (longitudinal, circumferential, and radial) axes. Speckle tracking echocardiography also allows the analysis of LV torsion. The aim of this paper was to review the main echocardiographic parameters of LV systolic function and to describe its pros and cons.

Myocardial deformation in pediatric patients with mucopolysaccharidoses: A two‐dimensional speckle tracking echocardiography study

“…However, subendocardial fibers were indirectly involved in myocardial impairment as LV twisting was lower in MPS than in healthy controls. LV twisting is due to opposite rotation of LV base (clockwise direction) and apex (counterclockwise direction), it being the result of the dynamic interaction between right‐hand–oriented subendocardial fibers and left‐handed subepicardial fibers …”

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

“…LV Twist () was defined as the net difference between the apical anticlockwise rotation and basal clockwise rotation. Torsion was defined as the twist normalized to the base-to-apex LV length measured at end-diastole (/cm) 13,14 . Twist rate was calculated as the peak velocity of twist (/second) 15 .…”

Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

“…The suspect of microvascular angina is only based on symptoms and ECG modifications, while echocardiography has not a relevant role, and overall it is still challenging. Speckle Tracking Echocardiography (STE) allows an objective and quantitative evaluation of ventricular deformation . In SE, it is a valuable detector of left ventricular (LV) systolic function abnormalities beyond the evaluation of wall motion .…”