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Hemodynamic Monitoring Using Echocardiography in the Critically Ill pp 79–88Cite as

Evaluation of Left Ventricular Systolic Function

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Abstract

Assessment of the left ventricular (LV) function is a very important step in the hemodynamic evaluation, not only for its contribution to diagnosis in heart and respiratory failure, but also for the guidance of therapeutic interventions.

Many indices have been developed, from eyeball evaluation of ejection fraction to very complex computations. Each has its strengths and limitations.

In routine clinical practice, LV ejection fraction (transthoracic approach, four-chamber view) or fractional area change should be measured (transesophageal or transthoracic echocardiography, short-axis view, midpapillary muscle level). Eyeball evaluation is sufficient in most cases for trained operators. If available, automated border detection may be used to facilitate measurements and reduce inter- and intraobserver variability. It should be noted that this measurement does not just estimate contractility: it is preload- and afterload sensitive. As such, it should be considered as the means to assess whether the left ventricle is adapted to the current loading conditions, with its intrinsic contractility. This measurement is, therefore, one of the most interesting indices of LV function for the intensivist.

In patients with mitral regurgitation and severe aortic regurgitation, noninvasive dP/dt measurements on regurgitant mitral flow can be used. Though less so than with other methods, these measurements are still affected by loading conditions and hence represent mostly LV contractility.

For research purposes, one may consider other indices of contractility (velocity of circumferential fiber shortening coupled with wall-stress measurement, LV hydraulic power), which are minimally affected by loading conditions. The significance of end-systolic elastance and the speckle-tracking method remains to be determined.

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Authors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808 route de Lennik, B-1070, Brussels, Belgium

    Daniel De Backer

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  1. Daniel De Backer
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Correspondence to Daniel De Backer .

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Editors and Affiliations

  1. , Department of Intenisve Care, Erasme University Hospital, route de Lennik 808, Bruxelles, 1070, Belgium

    Daniel de Backer

  2. Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, rue Ambroise Paré 2, Paris CX 10, 75475, France

    Bernard P. Cholley

  3. , Unité de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue Laennec, Amiens Cedex 1, 80054, France

    Michel Slama

  4. Ambroise Paré, Intensive Care & Reanimation Unit, Centre Hospitalier Universitaire, avenue Charles de Gaulle 9, Boulogne Cedex, 92104, France

    Antoine Vieillard-Baron

  5. Hôpital Dupuytren, Dépt. Soin Intensive, Université de Limoges, avenue Martin Luther King 2, Limoges, 87042, France

    Philippe Vignon

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De Backer, D. (2011). Evaluation of Left Ventricular Systolic Function. In: de Backer, D., Cholley, B., Slama, M., Vieillard-Baron, A., Vignon, P. (eds) Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-87956-5_8

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  • DOI: https://doi.org/10.1007/978-3-540-87956-5_8

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  • Print ISBN: 978-3-540-87954-1

  • Online ISBN: 978-3-540-87956-5

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