Final Feigenbaum’s Echocardiography DIGITAL

Chapter 5 Evaluation of Systolic Function of the Left Ventricle

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Chapter 5 Evaluation of Systolic Function of the Left Ventricle

FIGURE 5.23. A: Apical four-chamber view from which longitudinal strain has been recorded in 18 segments as per the current recommendation. The central figure is the apical four-chamber view with the myocardium automatically tracked by speckle tracking technology. Individual strain data for the visualized six segments as presented in the graph. The table at the upper right presents volumes and ejection fraction. B: Bull’s-eye plot of longitudinal strain obtained in the recommended 18 segments recorded in the same patient presented in panel A . A B

Evaluation of Systolic Function of the Left Ventricle

FIGURE 5.24. A: Longitudinal strain obtained in a patient with a dilated nonischemic cardiomyopathy. The apical long-axis view is presented. Indi- vidual graphs of the visualized seven segments are presented. B: Bull’s-eye plot of the global longitudinal strain for 17 segments recorded in the same patient presented in A. Note the calculated ejection fraction of 25.6% and the markedly reduced global longitudinal strain of –6.9%. A B

FIGURE 5.25. Apical four-chamber view recorded in a patient with less than ideal quality images. A represents an apical four-chamber view with superimposed tissue tracking for determination of longitudinal strain. This image is the first approximation created automatically by the ultrasound machine. Note that the lateral border is outside of the actual wall which is denoted by the arrow . Also note that the mid septum has been tracked in the right ventricular cavity. The inset at the lower right is the four-chamber view without tissue tracking. Note the prominent trabeculae on the right side of the septum ( dual arrows ) which were mistakenly tracked in the first approximation by the automatic system. The actual septum is delineated by the inward-pointing arrows . B is the same image after manual adjustment. Following this both the septal and lateral myocardium are more appropriately identified and tracked. Note the average strain of –21.6 and ejection fraction of 59.3%. A B

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