Left Ventricle (LV)

Obtain a Good PSLAX View

Left ventricular dimensions are measured from the parasternal long-axis view (PSLAX) using either M-mode or a 2D image. M-mode is a standardized measurement technique that allows assessment of cardiac structures and their motion over time. However, M-mode requires good image quality and a favorable cardiac position. If these conditions are not met, measurements should be performed from the 2D image. In patients with significant regional wall motion abnormalities, abnormal left ventricular geometry, or bundle branch block, left ventricular ejection fraction is more reliably assessed by planimetry. For M-mode, the cursor is positioned perpendicular to the long axis of the left ventricle so that it passes just distal to the tips of the open mitral valve leaflets.

Measurements from the Parasternal View

Once a high-quality PSLAX view and an appropriate M-mode cursor position have been obtained, press the M-mode button on the ultrasound system. Allow the tracing to scroll, and if the recording is of sufficient technical quality, freeze the image using the Freeze button. Measurements are then performed from the frozen image by selecting the desired parameter (e.g. left ventricular internal diameter in diastole) from the measurement menu. On some ultrasound systems this menu is called LV Study. Always measure from tissue to tissue.

Left Ventricular Measurement Using 2D Imaging

If an adequate M-mode cursor position cannot be obtained, measurements should be performed directly from the 2D image. The most important point is to select LVIDd and LVIDs from Calc → Dimensions, so that the ultrasound system recognizes which measurements are being performed.

Reporting the Results

Once the measurements have been stored by the ultrasound system, it automatically calculates several derived parameters, including EDV, EF, ESV, FS, IVS/LVPW, and LV Mass (Cubed). In the Turku region, it is customary to report only the measured dimensions together with EF. For example, if RV has not been measured, the findings shown below would typically be reported as: “LV 40/23, EF 75%. Walls 11/14.” Dimensions are reported in millimetres without explicitly writing the unit “mm”. Reporting practices vary between hospitals.