commonly used measures of left ventricular systolic...

COMMONLY USED MEASURES OF LEFT VENTRICULAR SYSTOLIC

FUNCTION (SHORTENING FRACTION AND EJECTION FRACTION) SHOW

A POOR ASSOCIATION WITH LEFT VENTRICULAR STROKE VOLUME

MEASURED BY ECHO AND MRI IN PRETERM NEONATES

Benjamim Ficial1,2, A. M. Groves2, E. Bonafiglia1,

A. Coghi1, C. Richelli1, R. Beghini1, A. Dall’Agnola3,

M. Ventola1, L. Pecoraro1, S. Lauriola1, M. Gentile1,

A. Bertolini1, S. Rugolotto1, A. Pietrobelli1,

E.M. Padovani1

1 Patologia e Terapia Intensiva Neonatale, Università

degli Studi di Verona

2 Imperial College and MRC Clinical Sciences Centre,

London

3 Pediatria e Patologia Neonatale, Ospedale “Silvio

Orlandi”, Bussolengo, Verona

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

BACKGROUND

?

BACKGROUND

HAEMODYNAMIC

INSTABILITY

BACKGROUND

HAEMODYNAMIC

INSTABILITY

LEFT VENTRICULAR

SYSTOLIC DYSFUNCTION

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

LEFT VENTRICLE SYSTOLIC FUNCTION

ASSESSMENT: FRACTIONAL SHORTENING (FS)

It looks at the degree of shortening of the left ventricular

diameter between end-diastole and end-systole

FS %= (EDD-ESD)/EDD

LEFT VENTRICLE SYSTOLIC FUNCTION

ASSESSMENT: EJECTION FRACTION (EF)

EF represents the volumetric fraction of blood pumped out of

the left ventricle.

EF = (EDV-ESV)/EDV

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

OBJECTIVES:

- to compare echo SF and LV stroke volume by validation against

Phase Contrast MRI (PCMRI) measurements

- to compare SF, EF and LV stroke volume measured by echo

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

MRI AND ECHO

- 15 neonates

- June - November 2012

- Hammersmith Hospital, NICU,

London

- 4 nCPAP

- birth weight (g)

- gestational age (wk)

- postnatal age at scan (wk)

- weight at scan (g)

1943 (640-3640)

33+4 (25-39)

36+3 (32-40)

1825 (890-2416)

MRI AND ECHO

Fractional shortening measured by echo showed a poor

correlation with PCMRI: r =0.240

LV stroke volume measured by echo showed a strong

correlation with PCMRI: r = 0.910

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

EJECTION FRACTION VERSUS

SHORTENING FRACTION

- 15 neonates

- February-March 2014

- Level III NICU, Università di

Verona

- Level II NICU, Bussolengo,

Verona

- 2 MV, 8 nCPAP

- birth weight (g)

- gestational age (wk)

- postnatal age at scan (wk)

- weight at scan (g)

1614 (680-2000)

31+2 (25+5-36+3)

32 (26+5-36+4)

1460 (600-2055)

EJECTION FRACTION VERSUS

SHORTENING FRACTION

Shortening Fraction showed a poor association with LV

stroke volume in preterm neonates: r= 0.272

Ejection Fraction showed a better association with LV

stroke volume in preterm neonates: r= 0.493

OUTLINE:

� BACKGROUND

� LEFT VENTRICLE SYSTOLIC FUNCTION ASSESSMENT

� OBJECTIVES

� MRI AND ECHO

� EJECTION FRACTION VERSUS SHORTENING FRACTION

� CONCLUSIONS

CONCLUSIONS:

- EF and SF do not show a strong association with LV stroke

volume measured by echo and MRI

- caution should be used when interpreting the findings at the

cot-side

- prefer EF to SF if abnormal septal wall motion

CONCLUSIONS:

- LV stroke volume measured by echo showed significant

potential to enhance our ability to detect true changes in left

ventricular performance

CONCLUSIONS:

Gruppo di Studio di Cardiologia Neonatale

Grazie!

Benjamim Ficialbenjamim.ficial@gmail.com