A Gandhi, M Gandhi, S Kalra
A Gandhi, M Gandhi, S Kalra. echocardiograpy reports -what a family physician should know?. The Internet Journal of Family Practice. 2009 Volume 8 Number 1.
Transthoracic echocardiography (TTE) is a reliable and versatile tool for the assessment of cardiac structure, function and path physiology. It is very cost effective compared with competing technologies and has many new possibilities as to how this examination can be improved and provide more and better information.1
Referring physicians sometimes find reported results
difficult to apply clinically. Terminology can be arcane. The format of reports differs from one laboratory to another. Content can vary: because echocardiography is evolving, some institutions use methods not available at all centers.2 This overview will help referring physicians structure their approach to extracting clinically useful information from TTE reports.
Content Of Tte Reports
because it relates LV mass to body surface area. Did laboratory staff measure the patient’s height and weight, or did they merely ask the patient to estimate them? Inaccurate self-reporting leads to inaccurate calculations.
of DD are strong predictors of future nonvalvular atrial fibrillation in the elderly.10 Independent of systolic function, DD of any degree is a strong predictor of all-cause mortality.11 Modern echocardiography either reports diastolic function as normal or grades DD by class (1 through 4).12 Class 1 DD (impaired myocardial relaxation) was formerly called “mild DD,” an expression that is obsolete and misleading. In one series, class 1 DD was associated with an 8-fold increase in all-cause mortality within 5 years.11 Mortality increases with the severity of DD.Increased left atrial (LA) volume is a morphologic expression of DD, reflecting LV end diastolic pressure.13 It predicts development of atrial fibrillation.14 Size of the left atrium is usually represented by the transverse diameter of the chamber, although this measurement often underestimates the volume of an enlarged left atrium.
frequently misleading. Visualization by colour Doppler depends on the velocity of the jet, not the volume of blood. A small, high-velocity jet through a small orifice could thus appear to be more severe than a much larger, but slower, blood volume regurgitating through a larger orifice.15
An increasing number of laboratories quantify valvular regurgitation using the effective regurgitant orifice and the regurgitant volume of blood.16 Some reports refer to this as the “PISA” method (proximal isovelocity
reported. Pulmonary stenosis can be indicated by an increased pressure gradient across the valve.
embolic source in stroke.18,19 Suspect echogenic features that could represent anatomic structures, unusual artifacts, primary or secondary cardiac tumours, thrombi, or vegetations will also be reported. Technically difficult TTE images often cannot differentiate between lesions and artifacts. Reporting physicians will point out any concerns, possibly recommending transesophageal echocardiography for clarification.
pressure or pulmonary systolic pressure. Measurements are often elevated by obesity and hypertension, not just by pulmonary hypertension.
Intrahepatic lesions are sometimes identified and extrinsic masses compressing the heart are sometimes revealed
concerning treatment exceeds the mandate of a laboratory report, but many referring physicians appreciate recommendations for prophylactic antibiotics, when indicated. When TTE report conclusions fail to address the reason the procedure was ordered, chances are high that the reason was never stated on the requisition. Physician-to physician discussion can answer many queries and concerns often raised about this procedure (Table 1).
One imaging test cannot substitute for history taking and physical examination. In conjunction with clinical knowledge about the patient and a basic understanding of cardiac physiology, however, TTE is essential for cardiovascular evaluation and follow up. This brief review has outlined a structured approach to reading TTE reports and has addressed many issues encountered by referring physicians who receive these documents. Echocardiography is, however, evolving rapidly. Future development of innovative techniques and consequent changes and improvements in the reports that referring physicians receive from TTE procedures are sure to come.