Scaled scores are assigned to each segmental wall motion with the average providing a semiquantitative global assessment.

It has good agreement with estimated ejection fraction and other measures of ejection factor (Fig. 8-1).

Obtained from the transgastric short-axis view

The proportion of left ventricular (LV) chamber diastolic area in the mid-papillary short-axis view that is reduced during systole.

Fraction area change (FAC)% = [end diastolic area – end systolic area] × 100/end diastolic area

Often estimated visually

Chamber circumference can be traced in systole and diastole to provide more accurate calculation.

May miss wall motion abnormalities outside the one measured plane

Limited accuracy for assessment of overall ventricular function

Oblique planes may reduce accuracy.

Measure volume change (stroke volume) of the whole ventricle rather than area change of a single plane

More accurate measure of global ventricular function

EF% = [end diastolic volume – end systolic volume] × 100/end diastolic volume

Normal ejection fraction is 55% to 75%

Single-plane ellipsoid method

Cylinder hemiellipsoid method

Area-length method

Estimate volume from diameter and length measurements in one or two planes.

Geometric assumptions limit accuracy of EF, when RWMA or unusual ventricular shapes are present

If measurement does not include the true apex (i.e., foreshortened view), then volumes and EF will also be unreliable.

Considered the best method for deriving ventricular volumes and ejection fraction

The endocardial border is traced in two orthogonal planes (e.g., midesophageal four-chamber and two-chamber views).

Computer software models the ventricle as a series of 20 or more stacked elliptical disks.

The volume of each disk is then calculated from the thickness of the disk, the diameters of each ellipsoid disk, and all of summed volumes to yield the total volume of the ventricle.

Cylindrical disks or rotating ellipsoid models can be generated from a single tomographic view, but with reduced accuracy, of one image plane (long axis).

Validated (angiography)

LV divided equal diameters

Cylindrical slices summed

Allows for variably shaped ventricles

Can account for significant regional wall motion abnormalities, but can still be limited by image quality or foreshortened views

Two views should not be combined if the chamber lengths differ by greater than 20% to reduce foreshortening errors.

TEE versus angiographic data is comparable (Table 8-1)¹

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