Please generate a complete transthoracic echocardiography report.

Transthoracic Echocardiography Report Template

A comprehensive transthoracic echocardiography report should follow a standardized, structured format that systematically evaluates all cardiac chambers, valves, and hemodynamic parameters according to established guidelines 1.

Essential Report Components

Based on current European and American guidelines 2, 3, 1, a complete TTE report must include the following structured sections:

1. Patient Demographics and Clinical Indication

• Patient identification
• Date of examination
• Clinical indication for the study (e.g., shortness of breath, chest pain, heart failure, valvular disease assessment, arrhythmia evaluation)
• Relevant clinical history

2. Technical Quality Statement

Document image quality as adequate, suboptimal, or limited with specific reasons (e.g., body habitus, lung disease, poor acoustic windows) 4, 5.

3. Left Ventricular Assessment (Mandatory)

Dimensions and Volumes:

• LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD)
• LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) - preferably by 3D or biplane Simpson's method
• All measurements should be indexed to body surface area (BSA)

Systolic Function:

• LV ejection fraction (LVEF) with specific percentage
• Categorize as: normal (≥50%), mildly reduced (40-49%), moderately reduced (30-39%), or severely reduced (<30%)
• Regional wall motion abnormalities (specify segments using 16 or 17-segment model)
• Global longitudinal strain (GLS) when available - particularly important in cardiomyopathies and valvular disease 1

Wall Thickness:

• Interventricular septum thickness
• Posterior wall thickness
• LV mass and LV mass index (essential in hypertension and cardiomyopathies) 1

Geometry:

• Sphericity index (LV short-to-long axis ratio; cut-off 0.76 for remodeling) 1

4. Left Atrial Assessment (Mandatory)

• LA diameter (anteroposterior)
• LA volume (preferably biplane area-length or 3D method)
• LA volume index (indexed to BSA)
• LA function parameters when relevant 1

5. Right Ventricular Assessment (Mandatory)

• RV size (qualitative: normal, mildly/moderately/severely dilated)
• RV systolic function: TAPSE (tricuspid annular plane systolic excursion), S' velocity, fractional area change
• RV free wall strain when available
• RV wall thickness if abnormal 2

6. Right Atrial Assessment

• RA size (qualitative or RA area/volume)
• RA pressure estimation based on IVC characteristics

7. Valvular Assessment (Comprehensive for Each Valve)

For each valve, report:

Morphology:

• Leaflet/cusp structure, thickness, calcification, mobility
• Specific abnormalities (prolapse, vegetation, perforation, flail)

Stenosis (if present):

• Peak velocity, mean gradient
• Valve area (by continuity equation, planimetry, or pressure half-time as appropriate)
• Severity grading: mild, moderate, severe with specific criteria 3

Regurgitation (if present):

• Jet characteristics, vena contracta width
• Regurgitant volume and fraction when feasible
• Severity grading: trace, mild, moderate, severe 3

Prosthetic valves (if present):

• Type and position
• Gradients and effective orifice area
• Paravalvular regurgitation
• Evidence of dysfunction or thrombosis

Tricuspid valve specific:

• Tricuspid annular diameter in mid-systole (≥40 mm indicates need for annuloplasty consideration in left-sided valve surgery) 1

8. Diastolic Function Assessment (Mandatory)

• Mitral inflow pattern (E and A velocities, E/A ratio, deceleration time)
• Tissue Doppler: septal and lateral e' velocities
• E/e' ratio (average of septal and lateral)
• LA volume index
• Peak TR velocity
• Diastolic function grade: normal, grade I (impaired relaxation), grade II (pseudonormal), grade III (restrictive) 2

9. Pulmonary Artery Pressure Estimation

• Peak TR velocity
• Estimated RA pressure (based on IVC size and collapsibility)
• Calculated systolic pulmonary artery pressure (sPAP)
• Additional signs of pulmonary hypertension if present 2

10. Pericardium

• Presence/absence of effusion (if present: size, location, hemodynamic significance)
• Pericardial thickness if abnormal
• Signs of tamponade or constriction if relevant 2

11. Aorta and Great Vessels

• Aortic root diameter at sinuses of Valsalva
• Sinotubular junction diameter
• Proximal ascending aorta diameter
• All measurements indexed to BSA
• LVOT diameter and area
• Abnormalities: dilation, dissection, coarctation 6, 1

12. Additional Findings

• Intracardiac masses or thrombi
• Patent foramen ovale or atrial septal defect
• Ventricular septal defects
• Congenital abnormalities 2, 7

13. Hemodynamic Calculations

• Stroke volume (from LVOT)
• Cardiac output and cardiac index
• Regurgitant volumes when multiple valve lesions present 1

14. Summary and Clinical Correlation

Provide a concise summary that:

• Directly addresses the clinical indication
• Highlights abnormal findings with clinical significance
• Compares to prior studies when available
• Provides clear diagnostic conclusions
• Suggests follow-up timing when appropriate (e.g., severe AS: 6 months; moderate AS: yearly; mild AS without calcification: 2-3 years) 2

Key Reporting Principles

Avoid these common pitfalls 8, 4, 5:

• Never report measurements without reference ranges or severity classifications - always contextualize findings
• Acknowledge technical limitations explicitly - poor apical windows may miss apical thrombi, aneurysms, or apical HCM
• Index measurements to BSA - particularly critical in cardiomyopathies to avoid misdiagnosis
• Use quantitative measurements over qualitative descriptions whenever possible
• Report negative findings for high-risk conditions when clinically indicated (e.g., "no vegetation seen" in suspected endocarditis)

The report must be structured to guide clinical decision-making regarding morbidity and mortality - particularly timing of interventions in valvular disease, device therapy in heart failure, and risk stratification in cardiomyopathies 2, 1.