Left ventricular systolic function
Left ventricular systolic function assessment is an essential component of the echocardiographic assessment of the critically ill patient. A wide range of diseases from sepsis to coronary ischaemia can affect the left ventricle (LV). An understanding of the events and timings in LV systole within the cardiac cycle is important, together with an appreciation of LV anatomy and geometry. Advanced echocardiography requires the competence to obtain all the imaging planes relevant to the LV in transthoracic (TTE) and transoesophageal (TOE) echocardiography. Ejection fraction is currently regarded as the gold standard for LV function and biplane Simpson’s method is the most accurate way to measure this at the critical care bedside, although newer applications such as strain may become more widely used in future. Imaging can be technically difficult in critically ill patients and a detailed knowledge of sources of technical error and physiological confounders is crucial. For the same reason, a knowledge of the alternative methods of LV systolic assessment to employ is also important. Many intrinsic diseases of the heart will be encountered in daily practice and require communication and referral to cardiologists. It is important in this setting that both clinicians are able to converse in the universal language of echocardiography. A comprehensive knowledge of regional wall anatomy and function will enable prompt diagnosis and management of coronary syndromes, particularly as onset of dysfunction can be rapid and serious in critical illness. Finally, an understanding of LV function and assessment in the context of sepsis syndromes is a key concept.