Interpretation of 2D Echocardiography Measurements
Overall Assessment
These measurements demonstrate a structurally and functionally normal heart with preserved left ventricular systolic function (ejection fraction 59–61%), normal chamber dimensions, normal left atrial size, and mild asymmetric septal hypertrophy that does not meet criteria for pathologic left ventricular hypertrophy. 1
Left Ventricular Size and Volumes
LVIDD 4.39 cm is within normal limits for left ventricular internal diameter in diastole (normal range typically <5.3 cm for women, <5.9 cm for men). 1, 2
LVIDS 3.03 cm is normal for left ventricular internal diameter in systole. 1
LV diastolic volume 72.4 mL and systolic volume 28.4 mL are both normal, yielding a stroke volume of approximately 44 mL. 3
LV stroke volume index 23.69 mL/m² is at the lower end of normal but acceptable in the context of normal ejection fraction and cardiac output. 1
Left Ventricular Systolic Function
Fractional shortening 31% is normal (normal range ≥25–27%), indicating preserved radial contractile function. 1, 2
Simpson biplane ejection fraction 61% is normal (normal ≥53% for men, ≥54% for women by 2D methods). 3, 2
2D ejection fraction 59% confirms preserved systolic function, with both measurements concordant and within the normal range of 53–73%. 3
Left Ventricular Wall Thickness and Geometry
IVSd 1.02 cm represents mild septal thickening (normal upper limit ≤1.0 cm for women, ≤1.1 cm for men). 1
LVPWd 0.73 cm is normal for posterior wall thickness in diastole. 1
The relative wall thickness can be calculated as (2 × LVPWd) / LVIDD = (2 × 0.73) / 4.39 = 0.33, which is below the threshold of 0.42 for concentric remodeling, indicating normal geometry despite the mild septal prominence. 1
LV mass 122.8 g is normal (normal <162 g for women, <224 g for men); when indexed to body surface area, this would need to be calculated but is likely <110 g/m² for women or <125 g/m² for men, confirming the absence of left ventricular hypertrophy. 1
The pattern is best described as normal geometry with mild asymmetric septal prominence, not meeting criteria for concentric or eccentric hypertrophy. 1
Left Atrial Size
LA size 3.3 cm (anteroposterior diameter) is normal (normal <3.8–4.0 cm). 1, 2
LA volume 39.5 mL is normal. 1
LA volume index 21.1 mL/m² is normal (normal <34 mL/m²; mild enlargement 34–41 mL/m², moderate 42–48 mL/m², severe >48 mL/m²). 4, 2
Normal left atrial size excludes chronic diastolic dysfunction and indicates low risk for atrial fibrillation, stroke, and heart failure hospitalization. 4
Clinical Interpretation and Recommendations
Key Findings Summary
Normal left ventricular size, volumes, and systolic function with ejection fraction in the 59–61% range. 3, 2
Mild asymmetric septal thickening (IVSd 1.02 cm) with normal LV mass and relative wall thickness <0.42, indicating normal geometry rather than pathologic hypertrophy. 1
Normal left atrial size (volume index 21.1 mL/m²), which provides reassurance against chronic elevated filling pressures. 4, 2
Diagnostic Considerations
The mild septal prominence (1.02 cm) warrants correlation with blood pressure history; if hypertension is present, target blood pressure <130/80 mmHg to prevent progression to concentric hypertrophy. 1
Rule out hypertrophic cardiomyopathy by confirming that maximal wall thickness in all segments is <15 mm and that there is no systolic anterior motion of the mitral valve or left ventricular outflow tract obstruction. 1
The normal left atrial volume index excludes chronic diastolic dysfunction, but if clinical symptoms of dyspnea or exercise intolerance are present, perform comprehensive diastolic function assessment including E/A ratio, E/e′, and pulmonary vein flow patterns. 4, 5
Follow-Up Strategy
No routine echocardiographic follow-up is required if the patient is asymptomatic and has no cardiovascular risk factors. 1, 2
If hypertension is present, repeat echocardiography in 3–5 years to monitor for progression of septal thickening or development of left ventricular hypertrophy. 1
If symptoms develop (dyspnea, chest pain, palpitations), perform comprehensive reassessment including diastolic function parameters and consider stress echocardiography to evaluate for ischemia or dynamic outflow obstruction. 1
Critical Pitfalls to Avoid
Do not diagnose left ventricular hypertrophy based solely on IVSd 1.02 cm; the LV mass of 122.8 g is normal, and relative wall thickness is <0.42, confirming normal geometry. 1
Do not overlook the importance of indexing measurements to body surface area; absolute values can be misleading in patients at extremes of body size. 1, 2
Do not assume normal diastolic function solely from normal left atrial size; if clinical suspicion exists, perform comprehensive diastolic assessment including tissue Doppler and E/e′ ratio. 4, 5
Use biplane Simpson's method (61%) rather than 2D single-plane method (59%) as the primary ejection fraction measurement, as it is more accurate and reproducible. 1, 3