Routine Assessment of the Left Ventricle

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.