Assessment of systolic function

This chapter describes the different modalities for assessment of systolic function by transthoracic echocardiography. Firstly, the basic principles of physiology and the determinants of left ventricular (LV) performance are considered, followed by a systematic appraisal of the methodologies for global LV systolic function assessment. Starting with M-mode echocardiography, passing through the traditional two-dimensional echocardiography evaluation to three-dimensional echocardiography approaches, main strengths and limitations are described. Power Doppler usefulness, regarding stroke volume calculations and dP/dt measurement are summarily explained, taking into consideration the usual pitfalls found in daily practice. There is a section dedicated to regional systolic function evaluation, with the recommendations for standardized LV division and differential characteristics of wall motion abnormalities. Additionally, more recent approaches with tissue Doppler imaging and strain analyses for global and regional LV function assessment are described. Finally, a section is dedicated to right ventricle systolic function which describes all modalities of evaluation.