From the Guidelines
The patient's echocardiogram shows a normal heart rhythm with normal left ventricular structure and function, and therefore, no further intervention is required at this time. The left ventricle is normal in size with a diastolic diameter of 5.3 cm. There is no left ventricular hypertrophy, with normal septal and posterior wall thickness measurements (0.6 cm and 0.7 cm respectively). Systolic function is normal with an ejection fraction of 54% by Simpson's method and visually estimated at 55-60%. The left ventricular mass index is normal at 61 g/m². Diastolic function is also normal, as evidenced by an E/A ratio of 1.2, deceleration time of 209 ms, and normal tissue Doppler velocities (E' septal 13.2 cm/s, E' lateral 18.8 cm/s) with normal filling pressures (E/E' medial 9.2, E/E' lateral 6) 1.
These findings indicate a structurally and functionally normal left ventricle with no evidence of heart failure, hypertrophy, or other cardiac abnormalities. The guidelines for the management of heart failure do not apply to this patient as they have a normal left ventricular ejection fraction (LVEF) and no symptoms of heart failure 1. The patient's normal diastolic function is consistent with the recommendations for the evaluation of left ventricular diastolic function by echocardiography 1.
The patient's normal left ventricular structure and function are consistent with the guidelines for the diagnosis and management of chronic heart failure in the adult, which state that patients with normal LVEF and no symptoms of heart failure do not require further intervention 1. Therefore, based on the strongest and most recent evidence, no further intervention is required at this time.
From the Research
Left Ventricle Size and Function
- The left ventricle (LV) size is reported as normal with a chamber size of LVIDd 5.3 cm, which is within the normal range according to the study by 2.
- The LV mass index is 61 g/m², which is also within the normal range, as stated in the study by 3.
- The systolic function is reported as normal with an ejection fraction (EF) of 55-60% visually and 54% by Simpson's method, which is consistent with the normal ranges reported in the study by 2.
Diastolic Function
- The diastolic function is reported as normal with an E/A ratio of 1.2 and a deceleration time (DT) of 209 ms, which is consistent with the normal ranges reported in the study by 4.
- The E' septal and lateral values are 13.2 cm/s and 18.8 cm/s, respectively, and the E/E' medial and lateral values are 9.2 and 6, respectively, which are within the normal ranges, as stated in the study by 4.
Comparison with Normal Values
- The study by 3 provides normal values for LV size and function based on three-dimensional echocardiography, which may be more accurate than two-dimensional echocardiography, as stated in the study by 5.
- The study by 2 provides normal values for LV size and function based on a multicenter international study, which may be more representative of the global population.
- The study by 6 discusses the evolution of echocardiographic techniques for assessing LV function and highlights the importance of considering age, sex, and race when defining normal reference values, as also stated in the study by 3.