Does thick ventricular wall thickness and ventricular dysfunction on Echocardiogram (ECHO) warrant a cardiology referral?

From the Guidelines

Yes, findings of increased ventricular wall thickness and ventricular dysfunction on an echocardiogram warrant a cardiology referral. These abnormalities may indicate serious cardiac conditions such as hypertrophic cardiomyopathy, heart failure, or other structural heart diseases that require specialist evaluation and management. According to the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy 1, increased ventricular wall thickness and ventricular dysfunction are associated with a higher risk of adverse cardiac events, including arrhythmias, heart failure progression, and sudden cardiac death. The referral should be made promptly, with urgency determined by symptom severity and degree of dysfunction. A cardiologist can provide comprehensive assessment including additional testing (such as cardiac MRI, stress testing, or coronary angiography), establish a definitive diagnosis, and develop an appropriate treatment plan. Treatment might include medications like beta-blockers, ACE inhibitors, ARBs, or diuretics, depending on the underlying condition. While awaiting the cardiology appointment, the primary care physician should consider basic cardiac medications if symptoms are present, advise on activity limitations if severe dysfunction is noted, and monitor for worsening symptoms.

Some key considerations in the management of these patients include:

• Assessing the degree of ventricular dysfunction, with severe dysfunction (EF < 30%) indicating a higher risk of adverse outcomes 1
• Evaluating for signs of ventricular hypertrophy, with severe hypertrophy (wall thickness > 1.7 cm) indicating a higher risk of adverse outcomes 1
• Considering the presence of other risk factors, such as family history of sudden death, unexplained syncope, or nonsustained ventricular tachycardia 1
• Using echocardiography and other imaging modalities to guide diagnosis and management, with consideration of cardiac MRI or other advanced imaging techniques if necessary 1

Overall, early specialist involvement is crucial in the management of patients with increased ventricular wall thickness and ventricular dysfunction on echocardiogram, as these findings are associated with a higher risk of adverse cardiac events.

From the Research

Thick Ventricular Wall Thickness and Ventricular Dysfunction on ECHO

• Thick ventricular wall thickness and ventricular dysfunction on Echocardiogram (ECHO) can be indicative of various cardiac conditions, including hypertrophic cardiomyopathy (HCM) and left ventricular (LV) dysfunction 2, 3.
• The presence of LV diastolic dysfunction, as characterized by Doppler echocardiography, is associated with worse overall mortality in both symptomatic and asymptomatic patients 4.
• Echocardiographic regional wall motion abnormalities (RWMA) can be useful in detecting coronary artery disease (CAD) in patients with LV dysfunction and a normal-sized or dilated left ventricle 5.

Cardiology Referral

• Given the potential implications of thick ventricular wall thickness and ventricular dysfunction on ECHO, a cardiology referral may be warranted to further evaluate and manage the underlying condition 2, 3.
• A cardiology referral can provide access to advanced diagnostic testing, such as cardiac magnetic resonance imaging (CMR), which can help to accurately assess the extent of hypertrophy and guide treatment decisions 2, 6.
• The referral can also facilitate the development of a personalized treatment plan, which may include medications, lifestyle modifications, and other interventions to manage symptoms and slow disease progression.

Diagnostic Considerations

• Echocardiography is a commonly used diagnostic tool for assessing ventricular wall thickness and function, but it may have limitations in certain cases, such as moderate to severe hypertrophy 2.
• CMR can provide more accurate measurements of ventricular wall thickness and can help to identify areas of fibrosis and scarring, which can be important for risk stratification and treatment planning 2, 6.
• The use of contrast echocardiography can also help to improve the accuracy of echocardiographic measurements and provide additional diagnostic information 2.