Assessment of subclinical left ventricular systolic dysfunction in patients with asymptomatic severe aortic stenosis with preserved left ventricular systolic function by three‐dimensional speckle tracking echocardiography

Nahar, Nazmun; Haque, Tuhin; Kabiruzzaman, M; Khan, Munawar A; Choudhury, Sohel Reza; Malik, Fazila Tun Nesa

doi:10.1111/echo.15662

Cited by 1 publication

(1 citation statement)

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“…Also, studies have shown that more than 80% of deaths in asymptomatic patients occur before reaching the guideline-recommended threshold for surgical intervention ( 130 , 131 ). Hence, as in other settings of subclinical dysfunction, LVEF is not a sensitive marker of early LV systolic dysfunction compared with longitudinal and circumferential LV strains in identifying patients with impaired LV function, who require AVR, despite preserved LVEF ( 132 – 134 ).…”

Section: Limitations Of Lvef In Heart Valve Diseasementioning

confidence: 95%

Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations

Vancheri,

Longo,

Henein

2024

Front. Cardiovasc. Med.

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Risk stratification of cardiovascular death and treatment strategies in patients with heart failure (HF), the optimal timing for valve replacement, and the selection of patients for implantable cardioverter defibrillators are based on an echocardiographic calculation of left ventricular ejection fraction (LVEF) in most guidelines. As a marker of systolic function, LVEF has important limitations being affected by loading conditions and cavity geometry, as well as image quality, thus impacting inter- and intra-observer measurement variability. LVEF is a product of shortening of the three components of myocardial fibres: longitudinal, circumferential, and oblique. It is therefore a marker of global ejection performance based on cavity volume changes, rather than directly reflecting myocardial contractile function, hence may be normal even when myofibril's systolic function is impaired. Sub-endocardial longitudinal fibers are the most sensitive layers to ischemia, so when dysfunctional, the circumferential fibers may compensate for it and maintain the overall LVEF. Likewise, in patients with HF, LVEF is used to stratify subgroups, an approach that has prognostic implications but without a direct relationship. HF is a dynamic disease that may worsen or improve over time according to the underlying pathology. Such dynamicity impacts LVEF and its use to guide treatment. The same applies to changes in LVEF following interventional procedures. In this review, we analyze the clinical, pathophysiological, and technical limitations of LVEF across a wide range of cardiovascular pathologies.

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