Question

This is a right parasternal short axis view of the left ventricle of a healthy adult male Great Dane.

1. What parameters can we measure from M mode imaging of the left ventricle in dogs?
2. What is your subjective impression for this patient?
3.  Do you think this specific image would give accurate results? If not, what could you do to improve the image?

Answers

1. M mode imaging is used to obtain measurements of left ventricular size, as well as indices of systolic function such as fractional shortening and E point to septal separation (EPSS). It can also be useful in other situations such as looking for small volume pericardial effusion, and looking for evidence of increased right ventricular pressure.
2. Accurate measurements are required in order to obtain values for LV dimensions and fractional shortening in this patient, but the left ventricle internal dimension in diastole appears to be around 6cm. Based on breed-specific reference intervals, this could be within normal limits. The fractional shortening appears mildly reduced (an estimate is 16%).
3. In order to obtain reliable measurements, it is important to ensure that accurate images are obtained. When looking at the still B mode image at the top, the cursor is not positioned correctly, which will most likely have artificially reduced the LV dimensions, and may have affected the FS measurement. When obtaining M mode measurements, the cursor should be positioned between the papillary muscles and divide the LV exactly in half.  For measurements of fractional shortening and LV dimensions, the measurement should be taken at the level of the insertion of the chordae tendinae.

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