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 Ficial
[email protected]