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What Does The Following ECHO Test Report Indicate?
Posted on
Sun, 23 Aug 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 23 Aug 2015
Answered on
Tue, 15 Sep 2015
Last reviewed on
Question : Dr. Following to my posts of May-2015, I have a new issue that I travelled this month to XXXXXXX where I have taken a fresh Echo on 12-Aug which has different values especially the LVEDD is threating as it is 54 mm whereas when I sent Saudi Arabia echo report to it showed only 39mm with mild LVH. I am really confussed. Please go through both the reports and advice.
"I am living in Saudi Arabia and working in IT (under pressure) environment, hence I go quarterly to cardiologist for regular checkups, it has been 10 years and at times I had high BP (150/90 -160/90), doctor never prescribed me any medication during these years I underwent 4 times stress test (last one was three years before). Everything was normal, in May 2015 I was feeling more stress and I went to another cardiologist for checkup, he had asked for an ECHO test and told me that you have mild LVH (1.27cm) but this is not significant and your BP is 155/90 and we need to control it. At present he has prescribed me Olemesartan Medoxomil/Amlodipine Besilate (40/5 mg). The readings are IVSD - 12, PWd - 9, LVIDd - 39, LVIDs - 2.6, EF > 55% and all interpretation are normal. Since I travelled XXXXXXX this month I have taken an echo the readings are different and as follows Left Ant - 54, Left Ari - 30, Aorta - 23, IVSD - 9, LVIDD - 54, LVIDs - 30, LVPW - 9, EF - 65%, AO Flow - 1.6 M/s, PV Flow - 1.1 M/s, E.Velocity - 1.1 M/s, A.Velocity - 0.8 M/s and chambers, valves and impression are normal. He said everything is normal. But when I checked in the internet the LVIDD is near border to the reference point. What should I do and I am more stressed."
"I am living in Saudi Arabia and working in IT (under pressure) environment, hence I go quarterly to cardiologist for regular checkups, it has been 10 years and at times I had high BP (150/90 -160/90), doctor never prescribed me any medication during these years I underwent 4 times stress test (last one was three years before). Everything was normal, in May 2015 I was feeling more stress and I went to another cardiologist for checkup, he had asked for an ECHO test and told me that you have mild LVH (1.27cm) but this is not significant and your BP is 155/90 and we need to control it. At present he has prescribed me Olemesartan Medoxomil/Amlodipine Besilate (40/5 mg). The readings are IVSD - 12, PWd - 9, LVIDd - 39, LVIDs - 2.6, EF > 55% and all interpretation are normal. Since I travelled XXXXXXX this month I have taken an echo the readings are different and as follows Left Ant - 54, Left Ari - 30, Aorta - 23, IVSD - 9, LVIDD - 54, LVIDs - 30, LVPW - 9, EF - 65%, AO Flow - 1.6 M/s, PV Flow - 1.1 M/s, E.Velocity - 1.1 M/s, A.Velocity - 0.8 M/s and chambers, valves and impression are normal. He said everything is normal. But when I checked in the internet the LVIDD is near border to the reference point. What should I do and I am more stressed."
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Welcome and thank you for asking on HCM!
Regarding your concern, after reviewing your both cardiac ultrasound reports, I would explain that there is a miscalculation of LVIDd (left ventricular internal diameter in diastole), as the plane of measurement is not perpendicular to the LV posterior wall, and furthermore the distal measurement point is positioned just posterior to the distal margin of small mitral leaflet (and not properly positioned to the posterior wall endocardial surface. This has led to a smaller LVIDd diameter than it is in reality.
The last echo ((in India) shows a more correct alignment of the measurement plane in PLAX (parasternal long axis view), but yet it is difficult to identify correctly where the distal measuring point is positioned.
Furthermore, judging from the overall PLAX view, probably a higher intercostal space should have been utilized to yield a more correct left ventricular (and other structures as well) size.
I would advise you to relax, as these echo measurement fluctuations are common (there usually exists an inter-observer and even intra-observer variability), and as your last echo is closer to the real view of your heart size, everything is OK.
LVIDd of 54mm is quite normal for a healthy individual of your age (and average body size). Upper reference value for LVIDd is up to 59mm depending on body size (indexed diameters are used instead according to current guidelines).
So relax! Your both echo report do not show any serious cardiac disorders (they just lack some accuracy).
What I would recommend you is to keep paying attention to your health, avoid potential coronary risk factors (potential glucose intolerance, dyslipidemia, avoid close smoking contact, and especially hypertension).
You should closely monitor your BP values, and continue your antihypertensive therapy as prescribed by your doctor.
A healthy life style and diet is strongly encouraged.
Hope to have been helpful to you!
I remain at your disposal, if you would have further uncertainties.
Best regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Welcome and thank you for asking on HCM!
Regarding your concern, after reviewing your both cardiac ultrasound reports, I would explain that there is a miscalculation of LVIDd (left ventricular internal diameter in diastole), as the plane of measurement is not perpendicular to the LV posterior wall, and furthermore the distal measurement point is positioned just posterior to the distal margin of small mitral leaflet (and not properly positioned to the posterior wall endocardial surface. This has led to a smaller LVIDd diameter than it is in reality.
The last echo ((in India) shows a more correct alignment of the measurement plane in PLAX (parasternal long axis view), but yet it is difficult to identify correctly where the distal measuring point is positioned.
Furthermore, judging from the overall PLAX view, probably a higher intercostal space should have been utilized to yield a more correct left ventricular (and other structures as well) size.
I would advise you to relax, as these echo measurement fluctuations are common (there usually exists an inter-observer and even intra-observer variability), and as your last echo is closer to the real view of your heart size, everything is OK.
LVIDd of 54mm is quite normal for a healthy individual of your age (and average body size). Upper reference value for LVIDd is up to 59mm depending on body size (indexed diameters are used instead according to current guidelines).
So relax! Your both echo report do not show any serious cardiac disorders (they just lack some accuracy).
What I would recommend you is to keep paying attention to your health, avoid potential coronary risk factors (potential glucose intolerance, dyslipidemia, avoid close smoking contact, and especially hypertension).
You should closely monitor your BP values, and continue your antihypertensive therapy as prescribed by your doctor.
A healthy life style and diet is strongly encouraged.
Hope to have been helpful to you!
I remain at your disposal, if you would have further uncertainties.
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. When I am chatting with you, I am more relaxed and confident that I can get the right consultation.
What about the other measurements and conclusions of report both, are they normal range?
More than that I am really worried about the size of LVIDD is 54mm, as per one of the XXXXXXX Doctors whom I talked to yesterday said this is little bigger. The difference of measurement between both the report is 15mm. Is this possible, and a final small note when Saudi Arabian Doctor was doing the echo took one hour to do but the XXXXXXX Doctor finished in two minutes.
What about the other measurements and conclusions of report both, are they normal range?
More than that I am really worried about the size of LVIDD is 54mm, as per one of the XXXXXXX Doctors whom I talked to yesterday said this is little bigger. The difference of measurement between both the report is 15mm. Is this possible, and a final small note when Saudi Arabian Doctor was doing the echo took one hour to do but the XXXXXXX Doctor finished in two minutes.
Brief Answer:
It's just measurement inaccuracy.
Detailed Answer:
Hello dear Arshad!
I am glad to have been helpful to you!
As there exists a discrepancy on left ventricular wall thickness, and endocavitary diameters between two echo reports, and hence on LVEF (and this is because of measurements inaccuracies), all the other parameters are concluded completely normal (Aorta, Left atrium, right heart chambers, normal functioning valves [aortic, mitral, tricuspid, pulmonic], pericardium, inferior cava vein, etc.).
A 15 mm deviation in measuring LV dimensions is considered a pure miscalculation, derived completely from examiner measurements inaccuracy.
Regarding the time period necessary for an optimal standard cardiac ultrasound evaluation it may vay from 25 to 45 minutes (depending on patient related specifics (in overweight and acute patients the exam may last longer] and examiner experience).
As a general rule when concluding about concrete measurement values, an average of several measurements (3-5) is considered. That way the error rate would be quite low.
I would like to assure you that there is not a minimal doubt of underlying cardiac disorders derived by those two ECHO reports. So, just relax!
There is no reason to worry about!
Just follow a healthy daily regimen and enjoy your life!
Best wishes,
Dr. Iliri
It's just measurement inaccuracy.
Detailed Answer:
Hello dear Arshad!
I am glad to have been helpful to you!
As there exists a discrepancy on left ventricular wall thickness, and endocavitary diameters between two echo reports, and hence on LVEF (and this is because of measurements inaccuracies), all the other parameters are concluded completely normal (Aorta, Left atrium, right heart chambers, normal functioning valves [aortic, mitral, tricuspid, pulmonic], pericardium, inferior cava vein, etc.).
A 15 mm deviation in measuring LV dimensions is considered a pure miscalculation, derived completely from examiner measurements inaccuracy.
Regarding the time period necessary for an optimal standard cardiac ultrasound evaluation it may vay from 25 to 45 minutes (depending on patient related specifics (in overweight and acute patients the exam may last longer] and examiner experience).
As a general rule when concluding about concrete measurement values, an average of several measurements (3-5) is considered. That way the error rate would be quite low.
I would like to assure you that there is not a minimal doubt of underlying cardiac disorders derived by those two ECHO reports. So, just relax!
There is no reason to worry about!
Just follow a healthy daily regimen and enjoy your life!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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