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Controlled Clinical Trial
. 2012 Nov 20:10:45.
doi: 10.1186/1476-7120-10-45.

Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle

Hisao Yoshikawa  1 , Makoto Suzuki, Go Hashimoto, Yukiko Kusunose, Takenori Otsuka, Masato Nakamura, Kaoru Sugi
Affiliations
Controlled Clinical Trial

Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle

Hisao Yoshikawa et al. Cardiovasc Ultrasound. .

Abstract

Background: In patients with left ventricular hypertrophy (LVH), LV midwall fractional shortening (FS) is used as a measure of LV systolic performance that is more physiologically appropriate than conventional FS. For evaluation of LV volume and ejection fraction (EF), 2-dimensional (2D) echocardiography is more accurate than M-mode echocardiography. The purpose of this study was to assess systolic performance by midwall EF using 2D speckle tracking echocardiography (STE).

Methods: Sixty patients were enrolled in the study. Patients were divided into two groups with LVH (n = 30) and without LVH (control group, n = 30). LV systolic function was compared between the two groups and the relationships of left ventricular mass index (LVMI) with LV systolic parameters, including midwall EF, were investigated.

Results: Midwall EF in the LVH group was significantly lower than that in the control group (42.8±4.4% vs. 48.1±4.1%, p <0.0001). Midwall FS was also significantly lower in the LVH group (13.4±2.8% vs. 16.1±1.5%, p <0.0001), but EF did not differ significantly between the two groups. There were significant correlations between midwall EF and LVMI (r=0.731, p <0.0001) and between midwall FS and LVMI (r=0.693, p <0.0001), with midwall EF having the higher correlation.

Conclusions: These results show that midwall EF can be determined using 2D STE. Midwall EF can be used to monitor LV systolic dysfunction, which is not possible with conventional EF. Evaluation of midwall EF may allow assessment of new parameters of LV systolic function in patients with LV geometric variability.

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Figures

Figure 1
Figure 1
Examples of midwall EF measurements. (A) 4-chamber view. (B) 2-chamber view. The positioning of the midwall is determined by the landmark of the midpoint between the epicardial and endocardial borders. (C) Examples of midwall volume curve using speckle tracking method. EF = ejection fraction. EDV = end diastolic volume; ESV = end systolic volume.
Figure 2
Figure 2
Relationships between LVMI and systolic parameters in the 60 subjects in the study. (A) Relationship between LVMI and EF. (B) Relationship between LVMI and midwall FS. (C) Relationship between LVMI and midwall EF. The abbreviations are the same as those in Table 3. LVMI = left ventricular mass index.
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