Reduced left ventricular function

Ultrasound plays a key role in assessing left ventricular (LV) function, which is crucial in diagnosing heart failure. In patients with reduced LV function, the heart’s ability to pump blood effectively is compromised. Key ultrasound findings include poor wall motion, abnormal ventricular size, and reduced overall contraction.

For PoCUS users, the focus is on recognizing reduced or severely reduced LV function rather than specific measurements like ejection fraction, valve pathology, or other detailed assessments. Learning to recognize these patterns can be challenging and requires more training than other aspects of heart evaluation. This skill is developed through pattern recognition rather than precise measurements, and it is best learned by repeatedly examining and comparing ultrasound clips of both normal and reduced LV function. This qualitative visual method is known as EYEBALLING, and it is the recommended approach for PoCUS users when evaluating left ventricular function.

While cardiologists often rely on precise measurements, PoCUS practitioners can start with this simpler approach, focusing on eyeballing by observing overall heart chamber function across different views. This allows practitioners to classify LV function as normal, reduced, or severely reduced.

Key Parameters for Eyeballing Left Ventricular Function:

Reduced myocardial contraction and thickening of the left ventricular wall. There is less endocardial movement toward the center of the ventricle during systole, with less difference between the end-diastolic and end-systolic volume. The left ventricle often appears dilated, indicating poor contraction.

Longitudinal contraction of the ventricle: Evaluated in the apical 4-chamber (A4CH) view, it refers to the displacement of the mitral valve plane during systole, known as Mitral Annular Plane Systolic Excursion (MAPSE). MAPSE reflects left ventricular longitudinal contraction or shortening and accounts for approximately 60% of the stroke volume.