Routine Assessment of the Left Ventricle

  • Karima AddetiaEmail author
  • Luigi P. Badano
  • Roberto M. Lang


Non invasive assessment of left ventricular (LV) geometry and function is critically important for clinical decision making and represents the most frequent indication for an echocardiographic examination. Suitability for device implantation in patients with LV dysfunction, discontinuation of potentially cardiotoxic chemotherapy in cancer patients, indications to cardiac surgery or to treatment initiation in asymptomatic patients are among the most critical decisions that rely on an accurate measurement of LV ejection fraction. LV volume calculations by two-dimensional echocardiography is highly operator dependent, uses only partial information contained in a few predefined cross sections of the LV to assess global myocardial function, and relies on geometrical assumptions that may not be necessarily valid in every patient. In particular, geometric assumptions about LV shape make the calculations of LV volumes and ejection fraction more inaccurate in patients in whom this information is more critical (i.e. patients in whom there are extensive wall motion abnormalities or the LV geometry is distorted because of aneurysms). With three-dimensional echocardiography, we can measure (not calculate anymore!) LV volumes with no assumption regarding LV geometry. This technique has been extensively validated against cardiac magnetic resonance and was demonstrated to be more time-saving, reproducible, repeatable and accurate than conventional two-dimensional echocardiography for LV volumes and ejection fraction measurements.


Left ventricle Volumes Ejection fraction Shape 

Supplementary material

Video 5.1

Triplane analysis using 3D datasets of the left ventricle. Three apical views are obtained which share the same apex by selectively activating three lines of piezoelectric elements at 0°, 60° and 120°. Volumes are obtained applying the Simpson’s method of discs identical to that used with two-dimensional echocardiography (AVI 19136 kb)

Video 5.2a

3D of the left ventricle in a healthy subject (AVI 14027 kb)

Video 5.2b

3D of the left ventricle in a subject with hypertensive heart disease (AVI 3138 kb)

Video 5.2c

3D of the left ventricle in a subject with hypertensive heart disease no compaction (AVI 9584 kb)

Video 5.3a

Multislice display of the left ventricle in a healthy subject (AVI 20235 kb)

Video 5.3b

Multislice display of the left ventricle in a subject with hypertensive heart disease (AVI 2817 kb)

Video 5.3c

Multislice display of the left ventricle in a patient with ischemic heart disease. There is an aneurysm of the inferior wall (AVI 16013 kb)

Video 5.3d

Multislice display of the left ventricle in a patient with non-compaction (AVI 15557 kb)

Video 5.4a

Apical views in a patient with a wall motion abnormality (MP4 253 kb)

Video 5.4b

Apical views taken from a plane rotated 15° from the original (Video 5.4a) (MP4 255 kb)

Video 5.5a

Apical four-chamber view in a patient with recent anterior myocardial infarction (MP4 1003 kb)

Video 5.5b

Apical two-chamber view in a patient with recent anterior myocardial infarction (MP4 849 kb)

Video 5.5c

Apical three-chamber view in a patient with recent anterior myocardial infarction (MP4 1056 kb)

Video 5.6

Measurement of left ventricular volumes and ejection Left ventricular ejection fraction fraction using a 3DE data set of the left ventricle (MP4 375 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Karima Addetia
    • 1
    Email author
  • Luigi P. Badano
    • 2
  • Roberto M. Lang
    • 1
  1. 1.Noninvasive Cardiac Imaging Laboratories, Department of Medicine/Section of CardiologyUniversity of Chicago Medical CenterChicagoUSA
  2. 2.University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca HospitalMilanoItaly

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