Chamber ASE Guide

GUIDELINE READING
dr. Jefry Pinondang Sardi Sianipar

Supervisor : dr. Rille Puspitoadhi H, Sp.JP, FIHA
LEFT VENTRICULAR
• Measurement of LV Size
LEFT VENTRICULAR
• Measurement of LV Size
LV Volume
• LV volumes should be measured from
the apical four- and two-chamber
views
• No apical shorthening
• Exclude pap muscles and
trabeculation
• Use LV focus view
LV Volume
• An alternative method to
calculate LV volumes.
• The mid-LV crosssectional
area is computed by
planimetry in the parasternal
shortaxis view and the length
of the ventricle taken from
the midpoint of the annular
plane to the apex in the
apical four-chamber view
Normal Value for 2DE of LV Size
LV Global Systolic Function
EF (Ejection Fraction)
• EF is calculated from EDV and ESV estimates, using the following
formula :
• The biplane method of disks (modified Simpson’s rule) is the

currently recommended 2D method to assess LV EF by consensus of
this committee
EF (Ejection Fraction)
Global Longitudinal Strain (GLS)
• Lagrangian strain is defined as the change in length of an object
within a certain direction relative to its baseline length :
• The most commonly used strain-based measure of LV global systolic

function is GLS. It is usually assessed by speckle-tracking
echocardiography (STE)
• Because MLs is smaller than MLd, peak GLS is a negative number.

• A peak GLS in the range of 20% can be expected in a healthy person
LV Regional Function
Segmentation of Ventricle
• The ventricle is divided into segments.
• Segmentation schemes should reflect coronary perfusion territories.
• a 17-segment model is commonly used
LV Regional Function
Visual Assessment
• Regional myocardial function is assessed on the basis of the observed wall
thickening and endocardial motion of the myocardial segment.
• It is recommended that each segment be analyzed individually in multiple
views
• The following scoring system is recommended:
(1) normal or hyperkinetic
(2) hypokinetic (reduced thickening),
(3) akinetic (absent or negligible thickening, e.g., scar), and
(4) dyskinetic (systolic thinning or stretching, e.g., aneurysm).
LV Mass
• There are several methods that effectively calculate LV mass from M-
mode echocardiography, 2DE, and 3DE
• All measurements should be performed at the end of diastole
• M-mode (either blinded or 2D-guided) and 2D echocardiographic linear
measurements rely on geometric formulas to calculate the volume of
LV myocardium, while 3DE can measure it directly
• Reference upper limits of normal LV mass by linear measurements are
95 g/m2 in women and 115 g/m2 in men.
• Reference upper limits of normal LV mass by 2D measurements are 88
g/m2 in women and 102 g/m2 in men with 2D methods
• Finally, calculation of relative wall thickness (RWT) with the formula
• 2 posterior wall thickness)/(LV internal diameter at enddiastole)
• concentric (RWT > 0.42) or eccentric (RWT < 0.42) hypertrophy and
allows the identification of concentric remodeling (normal LV mass with
increased RWT)
LA Measurement
• LA size should be measured at the end of LV systole, when the LA
chamber is at its greatest dimension.
• The most widely used linear dimension is the LA anteroposterior (AP)
measurement in the parasternal long-axis view using M-mode
• AP linear dimension should not be used as the sole measure of LA
size.
• LA area can be planimetered in the apical four- and two-chamber
views and normal values for these parameters have been reported.1
RV Measurement
RV Systolic Function
Right Atrium Measurement
• Although the right atrium can be assessed from different views,
quantification of RA size is most commonly performed from the apical
four-chamber view
• The recommended parameter to assess RA size is RA volume,
calculated using single-plane area-length or disk summation
techniques in a dedicated apical four-chamber view.
• The normal ranges for 2D echocardiographic RA volume are 25 6 7
mL/m2 in men and 21 6 6 mL/m2 in women.

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GUIDELINE READING

dr. Jefry Pinondang Sardi Sianipar

• The biplane method of disks (modified Simpson’s rule) is the

• The most commonly used strain-based measure of LV global systolic

• Because MLs is smaller than MLd, peak GLS is a negative number.

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