Left ventricular shape assessment: a new simple diagnostic tool in stress echocardiography

Knowing that ventricular shape can be distorted by ischemia, we conducted this retrospective study to evaluate the value of left ventricular shape assessment as a diagnostic tool in stress echocardiography.

Forty studies (normal and abnormal dobutamine or exercise tests) were analyzed. All patients had normal systolic function at baseline. Endocardial borders were traced in diastole, in systole, at rest, and at peak stress. The endocardial border tracings (without corresponding video images) were presented to a blinded observer. Normal shape was defined as "rectangular or circular in parasternal long- and short-axis views, respectively, and triangular in the apical view." On the basis of those simple criteria for normal ventricular shape, the tracings were classified as normal or abnormal (ischemia) and results were compared with the wall-motion analysis of video images.

Sensitivity, specificity, and positive and negative predictive values for shape abnormalities were 95%. Thirty-eight of the 40 studies were accurately classified without looking at the video tapes of the studies.

Visual evaluation of ventricular shape can be very helpful in stress echocardiography. It can be easily accomplished even by someone with limited experience in this technique.