Left ventriculography Left Ventricular Ejection Fraction Assessment by Visual Estimation

Jump to navigation Jump to search

Coronary Angiography

Home

General Principles

Overview
Historical Perspective
Contraindications
Appropriate Use Criteria for Revascularization
Complications
Technique
Film Quality

Anatomy & Projection Angles

Normal Anatomy

Coronary arteries
Dominance
Right System
Left System
Left Main
Left Anterior Descending
Circumflex
Median Ramus

Anatomic Variants

Separate Ostia
Anomalous Origins
Case Example
Fistula

Projection Angles

Standard Views
Left Coronary Artery
Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count
TIMI Flow Grade
TIMI Grade 0 Flow
TIMI Grade 1 Flow
TIMI Grade 2 Flow
TIMI Grade 3 Flow
TIMI Grade 4 Flow
Pulsatile Flow
Deceleration

Myocardial Perfusion

TIMI Myocardial Perfusion Grade
TMP Grade 0
TMP Grade 0.5
TMP Grade 1
TMP Grade 2
TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Eccentricity
Irregularity
Ulceration
Intimal Flap
Aneurysm
Sawtooth Pattern
Length
Ostial location
Angulation
Proximal tortuosity
Degenerated SVG
Calcification
Total occlusion
Coronary Artery Thrombus
TIMI Thrombus Grade
TIMI Thrombus Grade 0
TIMI Thrombus Grade 1
TIMI Thrombus Grade 2
TIMI Thrombus Grade 3
TIMI Thrombus Grade 4
TIMI Thrombus Grade 5
TIMI Thrombus Grade 6

Lesion Morphology

Quantitative Coronary Angiography
Definitions of Preprocedural Lesion Morphology
Irregular Lesion
Disease Extent
Arterial Foreshortening
Infarct Related Artery
Restenosis
Degenerated SVG
Collaterals
Aneurysm
Bifurcation
Trifurcation
Ulceration

Left ventriculography

Technique
Quantification of LV Function
Quantification of Mitral Regurgitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Left ventricular ejection fraction (LVEF) can be visually estimated by comparing the contour of the left ventricle (LV) between the end-systolic frame and the end-diastolic frame on left ventriculography.

Calculation

By definition, the volume of blood within a ventricle at the end of diastole is the end-diastolic volume (EDV). Likewise, the volume of blood left in a ventricle at the end of systole (contraction) is the end-systolic volume (ESV). The difference between EDV and ESV is the stroke volume (SV). The ejection fraction is the fraction of the end-diastolic volume that is ejected with each beat; that is, it is stroke volume (SV) divided by end-diastolic volume (EDV):

<math>EF (\%) = \frac{SV}{EDV}\times100</math>

Where the stroke volume is given by:

<math>SV = EDV - ESV</math>

EF is inherently a relative measurement—as is any fraction, ratio, or percentage, whereas the stroke volume, end-diastolic volume or end-systolic volume are absolute measurements.

Classification

According to the ACC Heart Failure Clinical Toolkit, based on the quantitative results of LVEF assessment, left ventricular function can be classified into the following qualitative categories:

  • Hyperdynamic = LVEF greater than 70%
  • Normal = LVEF 50% to 70% (midpoint 60%)
  • Mild dysfunction = LVEF 40% to 49% (midpoint 45%)
  • Moderate dysfunction = LVEF 30% to 39% (midpoint 35%)
  • Severe dysfunction = LVEF less than 30%

Examples

Hyperdynamic (>70%)

Case 1: LVEF ≈ 75%

Normal LVEF (50–70%)

Case 2: LVEF ≈ 60%

Mild dysfunction (40–49%)

Case 3: LVEF ≈ 45%

Moderate dysfunction (30–39%)

Case 4: LVEF ≈ 35%