In a 33‑year‑old woman in sinus rhythm with a heart rate of 63 bpm, are the echocardiographic measurements and derived calculations (ejection fraction, fractional shortening, left‑ventricular mass, relative wall thickness, outflow‑tract velocities, transmitral Doppler indices, etc.) realistic and consistent with a normal heart?

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Echocardiographic Calculations Are Realistic and Consistent with Normal Cardiac Structure and Function

The echocardiographic measurements and derived calculations in this 33-year-old woman are realistic and fall within normal reference ranges, representing a structurally and functionally normal heart.

Verification of Key Measurements Against Guideline Standards

Left Ventricular Dimensions and Wall Thickness

The measured values align well with established normal ranges 1:

  • Septal thickness (IVSd): 1.01 cm falls within the normal female range of 0.6–0.9 cm (slightly at upper limit but acceptable)
  • Posterior wall thickness (LVPWd): 1.04 cm is at the upper limit of normal (0.6–0.9 cm for women)
  • LV internal diameter (LVIDd): 4.8 cm is normal for a woman
  • Relative wall thickness (RWT): 0.43 is just above the normal upper limit of 0.42 1

Important caveat: The RWT of 0.43 technically suggests mild concentric remodeling (RWT >0.42 with normal LV mass), though this is borderline. This pattern can be seen in young women, particularly those with athletic conditioning or mild hypertension, and does not necessarily indicate pathology 1.

Left Ventricular Mass

  • LV mass: 175.0 grams by linear method
  • Normal range for women: 67–162 grams 1

This value is mildly elevated (13 grams above the upper normal limit). However, without knowing the patient's body surface area (BSA), we cannot calculate the indexed LV mass (g/m²), which is the preferred metric. The guidelines emphasize that LV mass should be reported indexed to BSA, with upper limits of 95 g/m² for women by linear method 1. If this patient has a larger body habitus, the indexed value may normalize.

Systolic Function Parameters

  • Ejection fraction (Teichholz): 65.4% (reported as >55% qualitatively)
  • Fractional shortening (FS): 35.9%

Both values are excellent and within normal ranges. The Teichholz-derived EF of 65.4% correlates well with the fractional shortening of 35.9%, as FS ≥30% typically corresponds to normal systolic function 2. The relationship between FS and EF appears internally consistent.

Diastolic Function Parameters

The transmitral Doppler indices are appropriate for a 33-year-old woman 3:

  • MV E velocity: 83.1 cm/sec (normal)
  • MV A velocity: 54.6 cm/sec (normal)
  • E/A ratio: 1.52 (normal for young adult; E/A >1 is expected)
  • Deceleration time: 0.16 sec (160 ms) is short but can be normal in young, athletic individuals with vigorous relaxation

The E/A ratio >1 with preserved E velocity indicates normal LV relaxation and filling pressures, consistent with the patient's age 3.

Aortic Valve and Outflow Tract

  • LVOT velocities and gradients: All within normal physiologic ranges
  • Aortic valve max gradient: 8.4 mmHg (normal; <10 mmHg)
  • Aortic valve max velocity: 145.2 cm/sec (normal; <2.0 m/sec)
  • Doppler velocity index (DVI): 0.80 (normal; >0.25 rules out significant stenosis)

Aortic Root and Left Atrium

  • Aortic root diameter: 2.17 cm is small but may be normal for a young woman (normal range varies by BSA)
  • LA dimension: 3.8 cm is normal (upper limit ~4.0 cm for women)

Internal Consistency Check

The calculated stroke volume from the aortic valve (106.7 ml) is physiologically reasonable for a young woman at rest with a heart rate of 63 bpm, yielding a cardiac output of approximately 6.7 L/min—entirely normal.

The relationship between end-diastolic volume (106.4 ml by Teichholz), end-systolic volume (36.8 ml), and ejection fraction (65.4%) is mathematically consistent: (106.4 - 36.8)/106.4 = 65.4%.

Clinical Interpretation

This echocardiogram demonstrates:

  1. Normal LV systolic function with preserved EF and FS
  2. Normal diastolic function appropriate for age
  3. Borderline concentric remodeling (RWT 0.43) with mildly increased absolute LV mass
  4. Normal valve function across all four valves
  5. Normal chamber sizes and great vessel dimensions

The borderline findings (RWT 0.43, LV mass 175g) warrant consideration of:

  • Patient's BSA and height (to properly index LV mass)
  • Blood pressure status (hypertension can cause concentric remodeling)
  • Athletic activity (physiologic adaptation)
  • Measurement technique and reproducibility

The calculations are realistic and internally consistent. The mild elevation in absolute LV mass and borderline RWT are the only findings requiring clinical correlation, but these do not invalidate the overall assessment of a structurally normal heart with excellent function 1.

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References

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