From the Guidelines
The patient's echocardiogram results indicate a structurally normal heart with preserved systolic and diastolic function, suggesting no immediate need for cardiac-specific interventions based on these findings alone. The left ventricle has a normal chamber size (LVIDd 5.3 cm), which is consistent with guidelines that emphasize the importance of left ventricular dimensions in assessing cardiac health 1. The normal wall thickness without hypertrophy (IVSd 0.6 cm, LVPWd 0.7 cm) and normal systolic function with an ejection fraction of 54-60% are key indicators of cardiac health, as highlighted by the distinction between HFrEF and HFpEF in the context of LVEF 1.
The diastolic function is also normal, as evidenced by an E/A ratio of 1.2 and appropriate tissue Doppler velocities (E' Septal 13.2 cm/s, E' Lateral 18.8 cm/s), which are crucial for assessing the heart's ability to relax and fill between contractions. The left atrium is normal in size with a low indexed volume of 8.3 ml/m², and the right ventricle demonstrates normal wall thickness, chamber size (RVID mid 2.5 cm), and systolic function (TAPSE 2.6 cm). These comprehensive findings suggest that the patient does not have the structural or functional alterations typically associated with heart failure, as outlined in guidelines that require additional supportive findings beyond signs or symptoms of HF, including elevated levels of natriuretic peptide and objective evidence of structural or functional alterations 1.
Given the normal cardiac parameters, the focus should be on maintaining adequate cardiovascular health through lifestyle modifications and monitoring, rather than initiating specific cardiac interventions. However, these findings should be interpreted in the context of the patient's clinical presentation and symptoms, as the clinical syndrome of HF may result from various disorders affecting the heart, and abnormalities of systolic and diastolic function can coexist irrespective of ejection fraction 1.
From the Research
Left Ventricle Assessment
- The left ventricle chamber size is normal with a left ventricular internal dimension at end-diastole (LVIDd) of 5.3 cm 2.
- The left ventricular hypertrophy (LVH) is normal with an interventricular septal thickness at end-diastole (IVSd) of 0.6 cm and a left ventricular posterior wall thickness at end-diastole (LVPWd) of 0.7 cm.
- The systolic function is normal with an ejection fraction (EF) of 55-60% and a mass index of 61 g/m².
Diastolic Function Assessment
- The diastolic function is normal with an E/A ratio of 1.2 and a deceleration time (DT) of 209 ms 2.
- The E' septal and lateral velocities are 13.2 cm/s and 18.8 cm/s, respectively, indicating normal diastolic function.
- The E/E' medial and lateral ratios are 9.2 and 6.5, respectively, which are within normal limits.
Left Atrium Assessment
- The left atrium size is normal with a trace indexed volume of 8.3 ml/m² 3.
Right Ventricle Assessment
- The right ventricle wall thickness is normal, and the chamber size is normal with a right ventricular internal dimension at end-diastole (RVID) of 2.5 cm 4.
- The systolic function is normal with a tricuspid annular plane systolic excursion (TAPSE) of 2.6 cm.
Clinical Implications
- The assessment of left ventricle, left atrium, and right ventricle is crucial in evaluating cardiovascular diseases, especially in patients with diabetes mellitus 5, 6.
- Echocardiography plays a central role in the evaluation of heart failure with preserved ejection fraction (HFpEF) and provides valuable information on cardiac structure, function, and hemodynamics 4.