How do I interpret cardiac echo results?

How to Read Cardiac Echo Results

A cardiac echocardiogram should be interpreted systematically, focusing on cardiac structure, function, and hemodynamics to evaluate morbidity, mortality, and quality of life outcomes.

Understanding the Echo Report Structure

• Echo reports should include demographic data, type of machine used, and quality of imaging to properly contextualize findings 1
• Reports should clearly answer the clinical question that prompted the study and be clinically oriented toward disease management and treatment 1
• Abnormal findings should be highlighted first, with normal reference values provided to differentiate normal from pathological conditions 1

Key Components to Evaluate

Left Ventricular Assessment

• Evaluate left ventricular size (diameters and volumes), wall thickness, and mass 1
• Assess systolic function through ejection fraction (normal >54% for men, >57% for women) 1
• Look for wall motion abnormalities that may indicate previous myocardial infarction or ischemia 1
• Review global longitudinal strain (GLS) when available (normal >20%), which can detect subtle systolic dysfunction even when ejection fraction is preserved 1

Diastolic Function

• Evaluate diastolic parameters including E/A ratio, deceleration time, and tissue Doppler e' velocity 1
• Calculate E/e' ratio to estimate left ventricular filling pressures (E/e' ≥13 suggests diastolic dysfunction) 2
• Approximately one-third of patients with heart failure symptoms have normal ejection fraction but abnormal diastolic function 3

Valvular Assessment

• Examine valve morphology and motion 1
• Quantify stenosis severity through valve area and pressure gradients 1
• Assess regurgitation and determine if it's transvalvular or perivalvular 1
• Ensure concordance between physical examination findings and echo results, as discrepancies may require further evaluation 1

Chamber Dimensions

• Measure left atrial volume (indexed to body surface area) as it reflects chronic diastolic function 1
• Evaluate right ventricular size and function, including TAPSE (tricuspid annular plane systolic excursion) 1
• Assess right atrial size and pressure estimates 1

Hemodynamic Parameters

• Review estimated pulmonary artery systolic pressure 3
• Look for signs of increased left ventricular outflow tract gradient 1
• Check for pericardial effusion or tamponade physiology 1

Interpreting Results in Clinical Context

• Always integrate echo findings with clinical history and physical examination 1, 3
• A normal resting echocardiogram does not exclude coronary artery disease if no wall motion abnormalities are present 1
• Echo findings should be compared to previous studies when available to assess disease progression 1
• For valvular heart disease, ensure concordance between physical examination findings and echo results, as discrepancies may require further evaluation 1

Common Pitfalls to Avoid

• Overreliance on ejection fraction alone; subtle systolic dysfunction may be present despite normal EF 4
• Misinterpreting technical artifacts as pathological findings 1
• Failing to account for body size when interpreting chamber dimensions 1
• Overestimating mitral regurgitation severity with eccentric jets or in late systole 1
• Underestimating aortic stenosis severity in low-flow states 1
• Relying solely on the echo report without reviewing actual images when possible 1

When to Consider Additional Imaging

• When echocardiographic findings don't match clinical presentation 1
• For prosthetic valves with suspected dysfunction or infection 1
• When image quality is suboptimal or technical limitations exist 1
• For further evaluation of complex congenital heart disease 1

Remember that echocardiography is a powerful diagnostic tool but should complement, not replace, a thorough cardiovascular examination 1.