LV Analysis, Systole

Isovolumetric contraction time

Superimposed and synchronized M-mode tracings of the left ventricle with mitral valve (upper panel) and aortic root (lower panel). Phonocardiographic tracing at upper end and ECG tracing at lower end of figure. 

A2: First high frequency component of second heart sound on phonocardiogram.
A-C:
Time interval between A (peak anterior movement of anterior leaflet during atrial contraction) and C (mitral valve closure) points of M-mode mitral valve tracing. 
IVCT
: Isovolumetric contraction time. 
IVRT:
Isovolumetric relaxation time. 
M1:
First high frequency component of first heart sound on phonocardiogram. 
P
: ECG P wave
QR: Q and R wave of the ECG. 


Mitral valve E-septum separation

The separation is measured as the distance between the E point of the mitral valve and the corresponding (synchronous) interventricular left septal endocardium (vertical white arrow). Normal value < 6 mm. The small arrow points at the B-bump sign (see here).
[References: Massie 1977; D’Cruz 1979]
Distance between white dots (depth) = 10 mm

Normal mitral valve morphology and dynamics are shown in the lower panel. 

B. Left panel: mitral valve stenosis. Right panel: dilated cardiomyopathy.
Mitral E-septum separation cannot be used when mitral valve motion is restricted by valve stenosis. In this setting, the measurement does not reflect left ventricular dilatation and systolic dysfunction

C. Left panel: normal LV. Right panel: increased E-septum separation (vertical thick arrow).

From Fig 1 to 3. Progressive left ventricular dilatation and reduction of ejection fraction. Mitral E-septum separation increases with both ventricular dilatation and reduction of systolic function.

A: End-diastolic volume= 135 ml and EF= 54 %
B: End-diastolic volume= 170 ml and EF= 55 %
C: End-diastolic volume= 233 ml and EF= 33 %


Systolic excursion of aortic root

Fig. 1
Fig. 2

Systolic excursion of the aortic root

Fig. 1. The systolic anterior motion of the aortic root (AO, during S) is proportional to cardiac output. The diastolic backwards motion of the aortic root is determined by the emptying dynamics of the left atrium (LA) during left ventricular filling and thus also reflects the left ventricular diastolic filling pattern.  
AO: Aortic root; LA: Left atrium; RVOT: Right ventricular outflow tract; S: Systolic time interval (includes isovolumic contraction, ejection time and isovolumic relaxation). R: Early rapid left ventricular filling; C: Conduit left ventricular filling; A: Left ventricular end-diastolic filling (atrial contraction).
Calibration distance between white vertical dots = 10 mm 

Fig
. 2. Left panel: systolic anterior aortic root motion in a normal subject (= 18 mm). Right panel: reduced systolic anterior aortic root motion  (= 10 mm) in a patient with reduced left ventricular systolic function.  


Short axis fractional shortening

Calibration distance between white vertical dots = 10 mm 

M-Mode examination of the left ventricle using short axis diameters. Left panel: Correct positioning of M-mode cursor in the transthoracic parasternal long axis view to obtain the standard left ventricular M-mode tracing as shown above. 
Right panel: Measurement of LV diameters (cm).
End-diastolic at Q wave of ECG. End-systolic at either: a) end-systolic notching of IVS; b) first wide component of II heart sound (phonocardiogram); c) maximum anterior position of posterolateral wall.

Fractional shortening of LV diameters
[(end-diastolic – end-systolic) / end-diastolic] x 100
LV mean velocity of circumferential fibre shortening
Vcf
= (end-diastolic – end-systolic) / (ejection time x end-diastolic) (circ/sec)

IVS: interventricular septum; LV: left ventricular cavity; Phono: phonocardiographic tracing; PLW: postero-lateral wall; RV: right ventricular cavity; RVAW: RV anterior wall.


Left ventricular wall thickening 

Measurement of end-diastolic (red arrows synchronous with Q wave of ECG) and end-systolic (at maximum systolic wall thickness) left ventricular wall thickness.
Wall thickening (%): [(end-systolic thickness – end-diastolic thickness) / end-diastolic thickness] x 100

Measurement units: cm. Normal values: 
Interventricular septum= 34 – 50 %
Posterior wall= 43 – 61 %