Cardiac Function Assessment Techniques

Assessment of cardiac function encompasses a range of non-invasive and invasive modalities designed to quantify the mechanical and haemodynamic performance of the heart. Transthoracic and transoesophageal echocardiography form the clinical cornerstone, offering real-time two-dimensional and three-dimensional imaging to evaluate ventricular volumes, wall motion and Doppler-derived flow velocities. Tissue Doppler imaging and speckle tracking echocardiography have refined the analysis of regional myocardial deformation, thereby enabling early detection of subtle systolic or diastolic impairment. Cardiovascular magnetic resonance (CMR) provides high spatial resolution assessment of ventricular volumes, mass and myocardial tissue characterisation, while four-dimensional flow CMR extends this capability to intracavitary flow and haemodynamic force mapping. Computed tomography and nuclear imaging modalities yield complementary information on coronary anatomy and perfusion. In specialised research settings, pressure–volume loop analysis remains the gold standard for intrinsic contractile assessment. Emerging artificial intelligence algorithms have been applied to automate the quantification of key indices such as mitral annular plane systolic excursion and atrioventricular plane displacement, promising rapid, reproducible measurements suited to perioperative and intensive care applications throughout the globe.

Research from Nature Portfolio

Recent studies have highlighted the incremental prognostic value of diastolic hydraulic forces estimated by the atrioventricular area difference, demonstrating that this novel metric adds survival information beyond conventional diastolic dysfunction grading and E/e′ ratio. Another investigation employing four-dimensional flow CMR quantified global left ventricular haemodynamic forces across the cardiac cycle, revealing a strong correlation with ejection fraction but limited discrimination between preserved-ejection fraction heart failure subgroups. In a separate advance, cine CMR feature tracking was used to generate a comprehensive four-dimensional profile of mitral annular dynamics and morphology, showing that sparse subsets of radial slices are sufficient to capture excursion and velocity parameters with accuracy comparable to full-slice analyses. These findings collectively reinforce the potential of advanced CMR techniques for detailed mechanical and flow-based assessment of ventricular function.

Research from all publishers

In the ultrasound domain, a convolutional neural-network pipeline has been developed to derive mitral annular plane systolic excursion directly from three-dimensional transoesophageal echocardiography, achieving near-real-time, low-bias estimates that rival manual two-dimensional approaches. A pilot study evaluating mitral valve movement in the parasternal long-axis view proposed M-mode metrics analogous to E-point septal separation for diastolic function assessment, reporting high reproducibility and rapid acquisition despite limited correlation with Doppler indices. In cardiovascular magnetic resonance, an automated template-based algorithm for atrioventricular plane displacement tracking demonstrated parity with manual measurements in both systole and diastole, offering a low-bias, multi-centre-validated tool for quantifying longitudinal function without extensive manual input.

Cardiac Function Assessment Techniques publication trend

The graph below shows the total number of articles in cardiac function assessment techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Ejection fraction: The percentage of ventricular blood volume ejected during systole, commonly used to gauge global systolic function.

Mitral annular plane systolic excursion (MAPSE): The longitudinal displacement of the mitral annulus towards the apex during systole, reflecting long-axis ventricular function.

Atrioventricular area difference (AVAD): The cross-sectional area difference between the left ventricle and left atrium at end-diastole, used to estimate diastolic hydraulic forces.

Speckle tracking echocardiography: A method that follows natural acoustic markers within the myocardium to measure regional deformation and strain.

Haemodynamic force analysis: Application of flow-field calculations from four-dimensional imaging to quantify intracavitary blood flow forces throughout the cardiac cycle.

References

1. Automated estimation of mitral annular plane systolic excursion by artificial intelligence from 3D ultrasound recordings. Artificial Intelligence in Medicine (2023).
2. Decreased diastolic hydraulic forces incrementally associate with survival beyond conventional measures of diastolic dysfunction. Scientific Reports (2023).
3. A Pilot Study Evaluating LV Diastolic Function with M-Mode Measurement of Mitral Valve Movement in the Parasternal Long Axis View. Diagnostics (2023).
4. Time-resolved tracking of the atrioventricular plane displacement in Cardiovascular Magnetic Resonance (CMR) images. BMC Medical Imaging (2017).
5. Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking. Scientific Reports (2018).
6. Hemodynamic force analysis is not ready for clinical trials on HFpEF. Scientific Reports (2022).