ECHO 2013 / Quantifying the Left Heart (LV and LA) Basic and Advanced Measurements

3D Echo Function and Mass

•Does not rely on geometric assumptions

•Most commercial algorithms still userdependent

•Better agreement between observers than 2D

3D Echo Function and Mass

•Limitations

-Arrhythmias (splicing)

-image quality

-time for offline analysis (now can be done more quickly on newer systems)

•Technology has rapidly improved, making use more feasible

Left Atrium

•3 functions

-contractile pump for LV delivering 15 to 30% of filling

-reservoir for pulmonary venous return during ventricular systole

-conduit for passage of stored blood from LA to LV during early diastole

Left Atrium

•Good prognostic data on increased left atrial size (linear and volumetric)

Left Atrial Size

•All measurements are done at end-ventricular systole, when LA size is at its maximum

Left Atrial Size - Linear

•2D linear or 2D-guided M-Mode

•2D: trailing edge of posterior aspect of aortic root to leading edge of posterior wall of LA

Left Atrial Size - Linear

•Pitfalls

-Does not take into account 3D geometry of LA

-expansion of LA in pathologic states may be constrained in the AP dimension by sternum and spine

-expansion in supero-inferior or medial-lateral directions will be underestimaed

Left Atrial Size - Linear

•Not Recommended as the sole measurement to assess LA size

Left Atrial Size - Volumetric

•Recommended measurement is left atrial volume indexed to BSA