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, 12 (3), 228-34

A New Method for Quantification of Left Ventricular Systolic Function Using a Corrected Ejection Fraction

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A New Method for Quantification of Left Ventricular Systolic Function Using a Corrected Ejection Fraction

David H Maciver. Eur J Echocardiogr.

Abstract

Aims: Left ventricular ejection fraction (EF) is a suboptimal measure of ventricular function. Recent mathematical modelling of left ventricular contraction has shown that the EF is determined by both myocardial shortening (strain) and by end-diastolic wall thickness. Increasing end-diastolic wall thickness resulted in augmented radial wall thickening. This may result in a significant 'overestimation' of ventricular systolic function as assessed by the EF. This study proposes a new measure of ventricular systolic function, the corrected EF (EF(c)) to allow for the presence of concentric left ventricular hypertrophy (LVH).

Methods and results: The study uses a new two-layer, three-dimensional mathematical model of ventricular contraction. Changes in end-diastolic wall thickness in addition to long-axis and mid-wall circumferential strain were modelled. Iso-strain lines were obtained where myocardial shortening (strain) is constant; EF increases with increasing end-diastolic wall thickness. The corrected EF is determined by following the iso-strain lines to the equivalent EF in the absence of hypertrophy (e.g. 9 mm thickness). For example, an individual with a mean end-diastolic wall thickness of 20 mm and measured EF of 60% has a corrected EF (EF(c)) of 37%.

Conclusion: The study shows that the EF is determined by absolute wall thickening and provides a nomogram for comparing EF when LVH is present. The EF(c) is a potential new measure of left ventricular systolic function. Its possible role will need validating in mortality trials.

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