1. Interpreting Cardiac Echo Reports
By: Khoa Nguyen, PGY2

2. Learning Objectives
Understand the contents of an echocardiographic report
Interpret findings from an echocardiographic report in a systematic manner
Appreciate relative clinical value of various echocardiographic findings in different clinical scenarios

3. General Echo Report Outline
Date of Procedure
Left Ventricular Systolic Function
Reason For Test
Left Ventricular Diastolic Function
Image Quality
Valves
Rate and Rhythm
Mass or Thrombus
Chamber Sizes
Pericardium
Hypertrophy
Incidental Findings
Right Ventricular Function
Conclusions

4. Initial Quality Measures
Example
Name:     XXXXXXSex: F       Date/Time: 4/1/2018 1:54:04 PM
MRN #:    xxxxxxxxx        DOB: xxxxx Age: 48 years
ACC #:    xxxxxxxxxx        Ht:   cm BP: 123/ 94mmHg
Location: IP 78            Wt:  57.00 kg  BSA: 1.57 m² Heart Rate: 92 bpm
Referring Physician:  xxxxxxxxxxxxxxxxxxxxxxxxx , cc:
Indications:          METH INDUCED HEART FAILURE; NEW MURMUR; Heart failure,
                      unspecified I50.9; Cardiac murmur, unspecified R01.1
CPT Codes:            Complete Echocardiogram
Technical Quality:    Image quality for this study is good.
Procedures Performed: Complete Echocardiogram, including 2D, m-mode, spectral
                      Doppler and color Doppler was performed.
Date of Procedure
Reason for the test
Image Quality
Date of Procedure
Does this report reflect the patient’s current status?
Reason for the test
Stated: what clinical question was to have been answered?
Image Quality
Can vary from excellent to uninterpretable.
In technically difficulty studies, pathology “not seen” does not necessarily mean “not present”

5. Initial Parameters Rate and Rhythm Chamber Sizes Hypertrophy
Might atrial fibrillation, bradycardia, or tachycardia have interfered with assessment of left ventricular diastolic function?
Chamber Sizes
Is there evidence of dilation?
Hypertrophy
Wall thickness indicate concentric LVH vs ASH
In ASH, comment on presence or absence of dynamic outflow tract obstruction (SAM) is required
Septal bulge is common in the elderly but does not have the same clinical implications that ASH has in the younger patients

6. Right Ventricular Values
Example
Right Ventricle: The right ventricular size is severely enlarged. Global RV systolic function is severely reduced.
Pulmonary Artery: The tricuspid regurgitant velocity is 3.37 m/s; and with an assumed right atrial pressure of 15 mmHg, the estimated right ventricular systolic pressure is moderately elevated at 60 mmHg..
Pulmonary artery systolic function (PASP): estimated from tricuspid regurgitation jet, using modified Bernoulli’s principle
PASP = Right Ventricular Systolic Pressure (RVSP)
In absence of right ventricular outflow tract obstruction or pulmonic stenosis
Normal Range: 16 to 39 mmHg
Estimation of RV filling pressure or mean RA pressure is performed by evaluating IVC size and collapsibility
Right ventricular systolic pressure estimate can be increased by hypertension and obesity, not just pulmonary HTN

7. Left Ventricular Function
Example
Left Ventricle: The left ventricular internal size is severely increased. Borderline concentric left ventricular hypertrophy. There is global severely decreased left ventricular systolic function. Spectral Doppler shows restrictive pattern of LV diastolic filling. Left ventricular ejection fraction is 15% by visual estimation.
Grade 1 (normal) through 4 (severely abnormal) for systolic function
Grade 2 can be “normal” in atrial fibrillation
Grade 1 can be abnormal in mitral regurgitation
Wall motion
Global abnormalities suggest cardiomyopathy
Regional abnormalities suggest infarction
Comments on segmental myocardial thickness  thinned-out segment is likely to be scarred and unlikely to recovered regardless of treatment
LV systolic function: Assists w/ management of fluids and ionotropic support, decisions regarding myocardial revascularization, timing and choice of valve interventions, and need for cardiac resynchronization therapy

8. Valves Example Valve Stenosis Valve Area (Severe) cm2
Mean Gradient (Severe) mmHg
Aortic Valve
< 1
>40
Mitral Valve
> 10
Tricuspid Valve
> 5
Pulmonic Valve /
> 64
Mitral Valve: No evidence of mitral valve stenosis with a mean mitral valve gradient of 1.0 mmHg. Severe mitral valve regurgitation is seen.
Tricuspid Valve: Severe tricuspid regurgitation was seen. The flow in the hepatic veins is reversed during ventricular systole.
Aortic Valve: The aortic valve is tricuspid. No evidence of aortic valve regurgitation is seen.
Valve Regurgitation
Signs of Severe Disease
Aortic Valve
Central Jet, width ≥ 65% of LVOT
Vena contracta > 0.6cmς
Mitral Valve
Vena contracta width ≥ 0.7cm with large central MR jet (area < 40% of LA) 
Stenotic lesions: valve area and transvalvular gradients are the key parameters
Regurgitant lesions: jet size, effective regurgitant orifice area, regurgitant volume and fraction, and impact of regurgitation on upstream and downstream cardiac chambers
NOTE:
Valve gradients are exacerbated in presence of tachycardia and increased CO state
Regurgitant lesions are suppressed when SBP is reduced

9. Mass or Thrombus
Ability to detect lesions is only as good as the images obtained
Left atrial appendage is not visible via TTE

10. Pericardium
Pericardial effusion: presence of RA/RV diastolic collapse, significant respiratory variation in mitral and tricuspid inflow velocities, and non-collapsing IVC suggest underlying tamponade

11. Echocardiographic Conclusion Statements
Important cardiac findings
Suggestions for follow-up or other investigations
Treatment advice might be offered, but clinical decisions are made by physicians who have knowledge of their patients
Summary:
 1. Left atrium severely dilated.
 2. The left ventricular internal size is severely increased.
 3. Severely dilated right atrium.
 4. Borderline concentric left ventricular hypertrophy.
 5. Severe tricuspid regurgitation.
 6. Severe mitral valve regurgitation.
 7. No evidence of mitral valve stenosis.
 8. Severely enlarged right ventricle.
 9. Severely reduced RV systolic function.
10. Severely elevated pulmonary artery pressure
Example

12. Examples of Clinical Conditions and Things to Look for on Echo Report

13. Key Echocardiographic Findings Cont.

14. Key Echocardiographic Findings Cont

15. Citations
Bansal, M., & Sengupta, P. P. (2017). How to interpret an echocardiography report (for the non-imager)? Heart, 103(21), 1733–
McAlister, N. H., McAlister, N. K., & Buttoo, K. (2006). Understanding cardiac “echo” reports: Practical guide for referring physicians. Canadian Family Physician, 52(7), 869–874.