Fundamentals of left ventricular volume representation

The volume regulation graph is meant to relate the fundamental determinants of left ventricular (LV) function, namely end-systolic volume (ESV) and end-diastolic volume (EDV). This representation permits evaluation of the LV remodeling process, convenient stratification for clinically relevant covariates, as well as inscription of iso-stroke volume (SV) and iso-ejection fraction (EF) trajectories, the latter two as linear relationships. This retrospective study discusses LV volumetric parameters obtained from 155 patients (65 females) covering a wide spectrum of heart diseases. Volumes are measured for diagnostic purposes by biplane ventriculography. We graphically analyze the various relationships between clinically relevant LV data, namely SV, cardiac output, ESV, and EDV, all normalized for body surface area, in addition to the commonly used metric EF. Following a short historical introduction regarding the anatomy and the 3D visualization of the shape of the LV, various approaches to graphically present the relevant LV data are evaluated. Indeed, the most insightful picture displays ESV versus EDV, permitting consideration of diagnostic subgroups, effects of medication, and covariates such as gender or age.