Evaluation of Systolic Function of Left Ventricle

fibers is 10:1.This unique fiber arrangement produces opposite rotation at the base and the apex, resulting in torsion and wringling-like emptying.5 The midmyocardial fibers are responsible for the majority of inward shortening and ventricular ejection due to their predominance.The mechanical activity of the heart is preceded by electrical activity, and excitation-contraction coupling classically begins at the sinoatrial node.The coordinated and cyclic influx and efflux of calcium ions during depolarization and repolarization produce myofiber contraction and relaxation.6 Myocardial contraction produces ventricular systole and leads to left ventricular emptying into the aorta.Ventricular systole begins with mitral valve closure and isovolumetric contraction and is followed by ventricular ejection. Echocardiographic AssessmentSeveral echocardiographic modalities can perform global and regional LV systolic function.7,8 The commonly employed methods are: • Subjective assessment or eyeballing • M-mode-based measurement • 2D volumetric and Doppler-based assessment • 3D volumetric assessment • Wall motion analysis • Strain measurement IntroductIonAnatomical and functional characterization of the LV is important in diagnosis, management, and prognostication in the perioperative, daycare, and critical care settings.1 Several echocardiographic parameters need to be assessed to analyze the functionality of LV due to complex myofiber arrangement and contractility pattern. 2 In this review, left ventricular myocardial organization and echocardiographic parameters commonly used to assess left ventricular systolic function have been discussed.Additionally, the clinical and research importance of echocardiographic variables according to the guidelines has been emphasized. Selection Criteria and Search StrategyReferences for this review were identified through searches of PubMed with search items "Left ventricle anatomy," "left ventricular systolic function," "left ventricular contraction," "Echocardiographic assessment of left ventricular function," "echocardiography and left ventricular dimension," "left ventricular chamber quantification," "ejection fraction," "left ventricular strain," and "3 D echocardiography and left ventricular function."Articles were also extracted from the reference lists of searched articles.Only papers published in English were reviewed.We also included European and American guidelines related to chamber quantification of LV and strain analysis.Preferences were given to systematic reviews, randomized trials, registries, and observation studies with a higher sample population. Anatomy of LVThe left ventricle is a bullet-like prolate ellipsoid structure with a unique myofiber arrangement.Myocardial fibers are arranged in a helical manner and follow a gradual transition from right-handed epicardial fibers arrangement to left-handed subendocardial fibers arrangement.Subepicardial and subendocardial fibers are longitudinal fibers oriented in an oblique direction, while midmyocardial fibers are circumferential fibers oriented in a transverse direction.1,3,4 The ratio of circumferential to longitudinal