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

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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.

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Authors and Affiliations

  1. Cardiology Department of Cardiovascular Diseases, University of Siena, Policlinico Le Scotte, Viale Bracci No 1, 53100, Siena, Italy

    Matteo Cameli, Sergio Mondillo, Marco Solari, Francesca Maria Righini & Valentina Andrei

  2. Department of Clinical Medicine, Cardiovascular & Immunological Sciences, Federico II University School of Medicine, Naples, Italy

    Carla Contaldi

  3. Cardiology Department, Catholic University of Sacred Heart, Rome, Italy

    Eugenia De Marco

  4. Department of Cardiology, University of L’Aquila, L’Aquila, Italy

    Michele Di Mauro

  5. Dipartimento di Scienze Biomediche Avanzate, Federico II University, Naples, Italy

    Roberta Esposito, Sabina Gallina & Maurizio Galderisi

  6. Department of Cardiovascular and Neurological Science, University of Cagliari, Cagliari, Italy

    Roberta Montisci

  7. Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy

    Andrea Rossi

  8. Cardiology Service, CMSR-Veneto Medica, Altavilla Vicentina, VI, Italy

    Stefano Nistri

  9. Division of NonInvasive Cardiology, San Raffaele Hospital, Milan, Italy

    Eustachio Agricola

  10. Cardiology Unit, University of Ferrara, Ferrara, Italy

    Donato Mele

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  1. Matteo Cameli
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  2. Sergio Mondillo
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  3. Marco Solari
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  15. Eustachio Agricola
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Correspondence to Matteo Cameli.

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On behalf of Gruppo di Studio Ecocardiografia of the Società Italiana di Cardiologia.

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Cameli, M., Mondillo, S., Solari, M. et al. Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 21, 77–94 (2016). https://doi.org/10.1007/s10741-015-9521-8

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