What information is typically included in an Echocardiogram (ECHO) report for patients with a history of heart disease or those at risk for cardiovascular disease due to conditions like hypertension, diabetes, or hypercholesterolemia?

What Information is Included in an Echocardiogram Report

An echocardiogram report must include demographic data (age, height, weight, BSA), machine type and model, image quality assessment, quantitative measurements of cardiac chambers and function, valve assessment, and clinically-driven conclusions that directly answer the referral question. 1

Mandatory Demographic and Technical Information

Every ECHO report requires the following foundational elements:

• Patient demographics: Age, body height, and weight are mandatory because Doppler parameters of diastolic and systolic function are strongly age-dependent and must be interpreted accordingly 1
• Body surface area (BSA): Required for normalizing measurements like LV cavity diameters, LV mass, and LA volume 1
• Blood pressure and heart rhythm/rate: Must be documented at the time of examination 1
• Machine vendor and model: Essential due to inter-vendor variability, particularly for advanced parameters like global longitudinal strain 1
• Image quality grading: Should be categorized as optimal, fair, suboptimal, or poor, as this affects diagnostic reliability 1
• Dialysis status: For patients on dialysis, document whether pre- or post-dialysis 1

Left Ventricular Assessment

The report must include comprehensive LV evaluation:

• LV dimensions and volumes: End-diastolic and end-systolic diameters, with 2D or preferably 3D measurements of volumes 1
• LV ejection fraction (LVEF): Normal values are >54% for men and >57% for women using 3D echocardiography 1
• LV mass: Calculated and indexed to BSA for diagnosis of LV hypertrophy, particularly important in hypertensive and diabetic patients 1
• Global longitudinal strain (GLS): Normal value >20%, provides early detection of subclinical systolic dysfunction in hypertension and diabetes 1
• Regional wall motion: Assessment of all LV segments, particularly important in coronary artery disease 1, 2

Diastolic Function Parameters

Diastolic assessment is critical, especially in patients with heart failure:

• Transmitral early diastolic velocity (E wave) 1
• Mitral annular early diastolic velocity (e') using tissue Doppler 1
• E/e' ratio: Elevated ratios suggest increased LV filling pressures and predict cardiac events in hypertensive patients 1
• Deceleration time 1
• Left atrial volume index (LAVi): Reflects chronic diastolic dysfunction 1

Right Ventricular and Pulmonary Assessment

Right heart evaluation includes:

• RV dimensions and function: TAPSE (tricuspid annular plane systolic excursion) or s' velocity of lateral tricuspid annulus 1
• RV free wall global longitudinal strain: Normal value >23% 1
• Right atrial volume index (RAVi) 1
• Systolic pulmonary artery pressure (sPAP): Estimated from tricuspid regurgitation velocity using the modified Bernoulli equation 1, 3
• Inferior vena cava (IVC) assessment: For estimating right atrial pressure 1

Valve Assessment

For each valve, the report must document:

• Morphology: Structural appearance and any abnormalities 1, 4
• Stenosis severity: Valve area, mean gradient, peak velocity 1
• Regurgitation severity: Graded as mild, moderate, or severe with effective regurgitant orifice area (EROA) when applicable 1
• Mechanism of dysfunction: Particularly for mitral regurgitation using Carpentier's classification 4
• Hemodynamic consequences: Chamber dilation and ventricular compensation 1

Disease-Specific Reporting Requirements

For heart failure patients: The report must include LVEF, longitudinal function (preferably GLS), diastolic function with LV filling pressures, pulmonary pressure, and RV function 1

For coronary artery disease: Assessment of global and regional systolic function is mandatory, with longitudinal function providing additional prognostic information 1, 2

For cardiomyopathies: Include 2D measurements of wall thickness and cavity diameters, volumes, LVEF, GLS, and diastolic parameters 1

For hypertensive/diabetic patients: Document LV mass indexed to BSA, GLS for early subclinical changes, and E/e' ratio for filling pressures 1, 5

Pericardial and Additional Structures

The report should assess:

• Pericardial effusion: Presence, size, and hemodynamic significance 1, 3
• Intracardiac masses or thrombi: Particularly in right heart chambers with pulmonary embolism or left ventricle post-myocardial infarction 1, 3, 4
• Septal continuity: Document any septal defects 4

Report Conclusions

The conclusions must be concise but conclusive, answering the clinical question directly and highlighting abnormal findings first. 1 The report should:

• Provide clear diagnostic statements when possible 1
• Be clinically driven and oriented toward disease management 1
• Include normal reference values to differentiate normal from pathological conditions 1
• Use standardized semi-quantitative terms (mildly, moderately, severely abnormal) with defined cut-off values 1

Critical Pitfalls to Avoid

• Never report the same parameter using different techniques - this creates confusion 1
• Do not omit image quality assessment - poor quality images make advanced techniques like strain and 3D misleading 1
• Always normalize measurements for BSA - failure to do so leads to misdiagnosis of chamber enlargement or hypertrophy 1
• Do not assume normal echocardiography excludes significant disease - coronary artery disease can exist with normal resting echocardiography, and stress testing may be needed 1, 6
• Avoid incomplete valve assessment - must include both morphology and hemodynamic severity 1