Complete 2D Echocardiography Report Components
Mandatory Patient Demographics and Technical Information
A complete 2D echocardiography report must include comprehensive patient demographics, technical details, and structured anatomical and functional assessments with appropriate quantification based on clinical context. 1
Essential Patient Information
- Age, weight, height, gender, and body surface area (BSA) are mandatory for proper interpretation 1
- Heart rate, blood pressure, oxygen saturation, and respiratory rate should be documented 1
- Clinical indication, medical diagnosis, and ongoing therapy must be reported 1
- Image quality assessment (poor, sufficient, good, or excellent) is required 1
- Patient cooperation level should be documented 1
- Completeness of examination (partial, sufficient, good, excellent) 1
Technical Documentation
- Vendor and software employed for analysis must be reported, especially for advanced techniques like strain imaging and 3D echocardiography, due to significant inter-vendor variability 1, 2
- Source of nomograms and Z-scores used for measurements should be detailed 1
Anatomical Assessment (Segmental Analysis)
Cardiac Position and Connections
- Position of the heart and situs must always be reported 1
- Atrioventricular (AV) and ventriculoarterial (VA) connections should be documented 1
- Systemic and pulmonary venous return anatomy must be described 1
Chamber-Specific Requirements
Atria
- Anatomical details must always be reported 1
- Quantitation of atrial volume is advised in cases of AV defects or significant shunt lesions 1
- Volume measurements should use appropriate methods given the unpredictable atrial shape in certain conditions 1
Ventricles
- Description of systolic and diastolic function and dimensions of both left ventricle (LV) and right ventricle (RV) must always be performed 1
- Quantitation of ventricular size is mandatory in: shunt lesions, overload conditions, valvular lesions, or complex congenital heart disease with borderline ventricle 1
- Quantitation of ventricular systolic and diastolic function is mandatory when ventricular dysfunction is suspected clinically or detected during echocardiography, or during follow-up of ischemic damage, cardiomyopathy, or myocarditis 1
Left Ventricular Quantification
Mandatory LV Measurements
- End-diastolic and end-systolic volumes using 2D biplane method of disks 1, 2, 3
- Ejection fraction (EF) using 2D biplane method 1, 2, 3
- Interventricular septum and inferolateral wall thicknesses using 2D or 2D-guided M-mode 1
- LV internal dimensions measured at the base 2
- Volumes should be indexed to BSA (LVEDVi, LVESVi) for accurate interpretation 2
Advanced LV Parameters
- Global longitudinal strain (GLS) using speckle tracking echocardiography 1, 2
- Lateral mitral annular s' and e' wave velocities using tissue Doppler imaging 1
- LV mass when clinically indicated 3, 4
Right Ventricular Assessment
Mandatory RV Measurements
- Tricuspid annular plane systolic excursion (TAPSE) using M-mode 1
- Fractional area change using 2D imaging 1
- Free wall thickness 1
- Free wall s' wave velocity using tissue Doppler imaging 1
Optional RV Parameters
- End-diastolic and end-systolic volumes using 3D echocardiography when available 1
- RV ejection fraction using 3D echo 1
- RV free wall longitudinal strain: normal >23% (absolute value) 2
Important caveat: 2D RV measurements correlate weakly with MRI-derived volumes, particularly in patients with RV volume overload, so 3D assessment is preferred when available 5
Valvular Assessment
Mitral Valve
- Anatomical details must always be reported 1
- E and A wave velocities using pulsed-wave Doppler 1
- Semi-quantitative and quantitative assessment of regurgitation severity (vena contracta diameter, E wave velocity, pulmonary vein flow, PISA) 1
- Quantitation is required in cases of stenosis, insufficiency, or left/right disproportion 1
Aortic Valve
- Anatomical details must always be reported 1
- Assessment of insufficiency and stenosis 1
- Quantitation is required in cases of stenosis, insufficiency, hypoplasia, or dilatation 1
Tricuspid Valve
- Semi-quantitative assessment of regurgitation severity (vena contracta, PISA radius) 1
- Systolic atrioventricular gradient using continuous-wave Doppler 1
- Anatomical details must always be reported 1
Pulmonary Valve
Great Vessels and Vascular Structures
Aorta
- Root diameter using 2D imaging 1
- Ascending aorta diameter 1
- Aortic arch diameter 1
- Diameter at suture line (in transplant patients) 1
- Quantitation is required in cases of stenosis, insufficiency, hypoplasia, or dilatation 1
Pulmonary Arteries
- Anatomical details must always be reported 1
- Quantitation is required in cases of stenosis, hypoplasia, or dilatation 1
Aortic Arch and Main Vessels
- Anatomical details must always be reported 1
- Quantitation is required in cases of stenosis or dilatation 1
Additional Structures
Pericardium
- Presence and semi-quantitative assessment of effusion severity and extent 1
- Anatomical details must always be reported 1
Inferior Vena Cava and Hepatic Veins
- Expiratory diameter and respiratory collapse using 2D imaging 1
- Anatomical and functional details must always be reported 1
- Quantitation is required in cases of congestion 1
Abdominal Aorta
- Flow pattern (normal, demodulated, retrograde, vasoconstriction pattern) 1
- Maximum velocity, acceleration, and deceleration time 1
- Anatomical and functional details must always be reported 1
- Quantitation is required in cases of systemic hypoperfusion 1
Shunt Lesions
When defects are present:
- Direction of shunt and size of defect must be described 1
- LV-RV pressure difference must always be described in the presence of ventricular septal defect 1
Pediatric-Specific Considerations
Use of Z-Scores
- Z-scores are advised for quantification in pediatric age 1
- Z-scores are available for most parameters including strain and 3D techniques 1
- Source of Z-score nomograms must be documented due to significant variability between different sources 1
Age-Appropriate Quantification
- Qualitative functional description without quantification may be acceptable in neonates, infants, and pre-adolescent children for screening studies 1
- Minimum quantitative evaluation is advised in older children and/or with suspicion of congenital or acquired heart disease 1
- Sedation considerations should be factored into the completeness of examination, with lower threshold for sedation in pre-operative or clinically unstable patients 1
Report Structure and Format
Conclusions Section
- Concise and easy-to-understand conclusion that can be interpreted by professionals of all seniority levels 1
- In complex reports, a final short summary is helpful to provide an overview 1
- Should state whether findings are within normal range or specify abnormalities detected 1
Digital Reporting
- Digital reporting system is advised to save time and avoid manual typing errors 1
- Allows for review, comparison, storage, post-processing, and sharing of studies 1
Format Flexibility
- Single format may be acceptable for normal or quick post-operative/interventional follow-up examinations 1
- Lesion-specific formats may provide advantages in pre-operative/interventional examinations by promoting standardization and collecting all relevant information 1
- Flexibility is required in both single and lesion-specific formats 1
Signature
- Report must be signed by the interpreting physician 1
Common Pitfalls and Caveats
- Serial measurements should ideally be performed by the same observer to minimize interobserver variability 6
- Several cardiac cycles should be averaged for volume measurements to account for beat-to-beat variability 6
- Confidence limits for individual measurements: end-diastolic volume ±15%, end-systolic volume ±25%, ejection fraction ±10% 6
- 2D RV assessment has limitations, particularly in dilated RVs, and 3D methods are preferred when available 5
- Vendor-specific differences in strain measurements require using the same equipment for serial assessments 2
- Quantitative assessment is superior to qualitative due to significant inter- and intra-observer variability in qualitative assessments 1