Left Ventricle Outline

Anatomy of the Left Ventricle

• Introduction
• Anatomy
  • Endocardium
  • Moderator Bands
  • Papillary Muscles
  • Helical Heart
  • Suspension Unit

Geometry of the Left Ventricle

• Introduction
• Short Axis to Long Axis Ratios
  • Concentric Remodeling
  • Eccentric Hypertrophy
• Volume to Mass Ratios
• Symmetrical vs Asymmetrical Hypertrophy
• Relative Wall Thickness
• Ventricular Modeling
  • Concentric Remodeling
  • Concentric Hypertrophy
  • Hypertrophic Cardiomyopathy
  • Eccentric Hypertrophy
  • Dilated Cardiomyopathy
• Left Ventricular Shape
• Regional Shape
• Limitations

Cardiac Cycle of the Left Ventricle

• Cardiac Cycle
  • Systole
    • Isovolumic Contraction Time
    • Ejection
  • Diastole
    • Isovolumic Relaxation Time
    • Rapid Filling
    • Diastasis
    • Atrial Contraction
• Electrocardiogram and Phases of the Cardiac Cycle
• Left Ventricular Contraction
  • Myocardial Fibers
  • Short Axis Motion of the LV
  • Long Axis Motion of the LV
  • Wringing Motion

Global Systolic Function

• Introduction
• Factors Affecting Global Function
• Left Ventricular Global Indices
• Left Ventricular Systolic Indices

Cardiac Arterial Supply and Venous Drainage

• Coronary Artery Anatomy
  • Left Main Coronary Artery (LMCA)
  • Left Anterior Descending Artery (LAD)
  • Circumflex Coronary Artery (Cx)
  • Right Coronary Artery (RCA)
  • Posterior Descending Artery (PDA)
• Coronary Artery Dominance
• Coronary Artery - Wall Segment Relationship
• Variations of Coronary Blood Supply
  • Congenital Anomalies
    • Normal Perfusion
    • Abnormal Perfusion
    • Coronary Artery Fistulas
    • Pulmonary Artery Origin
• Venous Drainage of the Heart
  • Anterior Cardiac Vein
  • Great Cardiac Vein
  • Coronary Sinus

Left Ventricular Segments

• Introduction
• Segmentation of the Heart - 17 segment Model
  • Walls - Midesophageal View
  • Segments - Apical View
  • Segments (Midesophageal View)
  • Segments (All Views)
• Left Ventricular Segmentation (Interactive Page)

Wall Motion Analysis

• Border Definition and Tracing
  • Leading Edge Technique
• Wall Motion
  • Normal
• Wall Motion and Ischemic Heart Disease
  • Coronary Artery Blood Flow Dependence
  • Coronary Artery Stenosis
• Wall Motion Types
  • Hyperkinesis
  • Normokinesis
  • Hypokinesis
  • Akinesis
  • Dyskinesis
• Hypokinesis Grades
• Wall Motion Scores
• Wall Thickening
• Left Ventricular Aneurysms
  
• Adjacent Wall Abnormalities due to Infarction
  • Hibernation
  • Masked
• Clinical Significance of Segmental Wall Motion Abnormalities
• Epicardial Motion
• Wall Motion Misdiagnosis
• Intraobserver Error
• Nonischemic Wall Motion
  • Normal Motion Misdiagnosis
  • Conduction Abnormalities
    • Left Bundle Branch Block
    • Epicardial Pacing
    • Preexcitation Syndromes
    • Premature Ventricular Contractions
  • Postoperative Motion
    • Pericardium Closed
    • Pericardium Open
  • Pericardial Constriction
  • Tethering
  • Restriction
  • Rotation
  • Off-Axis Scans
  • Translation
  • Pseudothickening
  • Effect of Aging
• Quantitative Analysis of Regional Systolic Function
  • Wall Motion Analysis
    • Radial Coordinate System
    • Centerline Method
  • Regional wall Motion Analysis
  • Regional Wall Thickening Analysis
  • Intra and Interobserver Error
• Limitations

Myocardial Strain

• Strain
  • One Dimensional Strain
  • 2 Dimensional Strain
  • 3 Dimensional Strain
• Types of Strain
• Strain Rate
• Instantaneous Strain
• Velocity Gradient
• Coordinate Systems
• Cross Correlation Method
• Velocity Gradient Method

M Mode Evaluation of the Left Ventricle

• Introduction
• M Mode Measurements
  • Accuracy and Measurement vs 2D
  • Linear Measurements
    • Relative Wall Thickness
    • E Point Septal Separation
    • Limitations
  • Mass and Volume Measurements
    • Mass
      • Prolate Ellipsoid Method
    • Volume
  • Limitations

2D Evaluation of the Left Ventricle

• Introduction
• Foreshortening
• Left Ventricular Contraction
• Mass
  • Area-Length Method
• Fractional Area Change
• Ejection Fraction
• Fractional Shortening
• Circumferential Velocity Shortening
• Volume
  • Method of Discs (Simpson's Method)
  • Area-Length Method
  • Diameter-Length Method
  • Acoustic Quantification/Automatic Border Detection
  • Limitations
• Pressure-Volume Analysis
  • Pressure Volume Loops
  • Pressure Dimension Loops
  • Limitations
• Preload Determination
  • Left Atrial Size/Contractility
  • Interatrial Septum Movement
• Afterload/Wall Stress

Doppler Evaluation of the Left Ventricle

• Left Ventricular Systolic Function
  • Introduction
  • Velocity Time Integral (VTI)
  • Cross Sectional Area (CSA)
  • Stroke Volume
  • Cardiac Output
    • Measurements at the Proximal Ascending Aorta
  • Measurements at the LVOT or RVOT
  • Measurements at the Mitral Valve
  • Measurements at the Aortic Valve
  • Measurements at the Tricuspid Valve
  • Measurements at the Pulmonary Valve
  • Measurements at the Pulmonary Artery
  • Differences in Transvalvular Stroke Volumes
  • Pitfalls in Stroke Volume Measurements
• Magnetic Resonance Imaging (MRI)
• Other Measurements of Left Ventricular Function
  • Acceleration Time
  • dP/dt and -dP/dt
  • Tissue Doppler Echocardiography (TDE)
• Left Ventricular Inflow Doppler Evaluation
  • Isovolumic Relaxation Time
• Normal Left Ventricular Inflow Pattern
  • Deceleration Slope and Deceleration Time
  • Technical Considerations
  • 2D Imaging Plane
  • Pulse wave vs Continuous Wave
  • Sample Site
  • E and A Waves
  • Diastasis
  • Deceleration Slope vs Deceleration Time
• Myocardial Performance Index (Tei Index)

Phases of Diastole

• Introduction
• Phases of Diastole
  • Isovolumic Relaxation Time (IVRT)
    • Normal Relaxation
    • Decreased Relaxation
  • Rapid Filling Phase
  • Diastasis
  • Atrial Contraction
• Diastolic Function Measurements
• E and A Waves
• Pulmonary Vein Doppler Waves
• Peak -dP/dt
• Tau

Left Ventricular Filling Factors

• Normal Variations
  • Age
  • Heart Rate
  • Rhythm
  • Loading Conditions
  • Atrial Function
  • Respiration
  • Systolic Function
  • Valsalva Maneuver
• Diastolic Dysfunction

Factors of Diastolic Dysfunction of the Left Ventricle

• Factors
• Ventricular Relaxation
• Internal Factors
• External Factors
• Inactivation of Myocardial Contraction
• Ventricular Compliance

Echocardiographic Evaluation of Diastolic Dysfunction

• M Mode
  • B Bump
• 2D Evaluation
  • Left Atrial Size
• Filling Pressures by Doppler Evaluation in Diastolic Dysfunction
  • Left Atrial Pressure by Pulmonary Vein Systolic Fraction
  • Left Ventricular Inflow and Pulmonary Capillary Wedge Pressure Relationship
  • Left Ventricular A Wave and Pulmonary Vein Doppler A Wave Relationships
• Left Ventricular Inflow A Wave Duration in Diastolic Dysfunction

Advanced Echocardiographic Evaluation of Diastolic Dysfunction

• Tissue Doppler Echocardiography Mitral Annular Velocity
• Color M Mode Velocity of Propagation
• Tau or Time Constant of Relaxation
• Comparison of Diastolic Dysfunction Tests

Progression of Diastolic Dysfunction

• Mild Diastolic Dysfunction with Normal LVEDP (Impaired Relaxation)
• Mild Diastolic Dysfunction with Elevated LVEDP (Impaired Relaxation)
• Moderate Diastolic Dysfunction (Pseudonormalization)
• Severe Diastolic Dysfunction
• Comparison of Diastolic Dysfunction Tests