Echocardiography

A Practical Guide for Reporting and Interpretation, Third Edition

Helen Rimington, John Chambers

• Publisher: CRC Press
• Year: 2015
• Print ISBN: 9781138409910
• eBook ISBN: 9780429586309
• Edition: 3
• Topic: Medicine
• Subtopic: Cardiology

Echocardiography: A Practical Guide for Reporting and Interpretation is a step-by-step guide to clinical echocardiography. This new edition has been extensively revised and includes new international guidelines, grading criteria and normal data. The book presents an up-to-date discussion of echocardiography use in both acute and critical care setti

Introduction

1

Minimum standard echocardiogram

• A minimum set of views and measurements is necessary for every standard echocardiogram (ECG)^{1, 2, 3, 4} to:

• reduce the risk of missing abnormalities

• help minimise variability between operators and over serial studies

• provide an instrument for quality control.

• Further views and measurements are dictated by the reason for the request or the findings at the initial study and are discussed in each chapter.

• The template below is needed before a study can be reported as normal. A universal consensus does not exist for the italicised items.

The minimum standard adult transthoracic study

General

• Name and unique identifiers

• ECG for rhythm and ventricular rate

Two-dimensional (2D) sections

• Parasternal long-axis

• Parasternal long-axis modified to show the right ventricular (RV) inflow and outflow

• Parasternal short-axis at the following levels:

• aortic valve

• mitral leaflet tips

• papillary muscles

• Apical views:

• 4-chamber

• 5-chamber

• 2-chamber

• long-axis

• Subcostal views to show the right ventricle, atrial septum and inferior vena cava (IVC)

• Suprasternal view

2D or M-mode measurements

• Left ventricular (LV) dimensions from the parasternal long-axis or short-axis view:

• septal thickness at end diastole

• cavity size at end diastole

• posterior wall thickness at end diastole

• cavity size at end systole

• Aortic root dimension

• Left atrial anteroposterior diameter

• RV size from maximum diameter

Colour Doppler mapping

• For the pulmonary valve in at least one imaging plane

• For all other valves in at least two imaging planes

• Atrial septum in one plane

• Aortic arch in suprasternal view

Spectral Doppler

• Pulsed Doppler at the tip of the mitral leaflets in the apical 4-chamber view. Measure peak E and A velocities and E deceleration time

• Pulsed Doppler in the left ventricular outflow tract. Measure systolic velocity integral

• Continuous-wave Doppler across the aortic valve in the apical five-chamber view. Measure the peak velocity

• Continuous-wave Doppler across the tricuspid valve if tricuspid regurgitation is seen on colour Doppler. Note peak velocity

• Pulsed or continuous-wave Doppler in the pulmonary artery

• Pulsed tissue Doppler at the mitral annulus

• Pulsed tissue Doppler at the lateral tricuspid annulus

Organisation of a report

A report should include:

• demographic and other data

• measurements (Doppler and M-mode or 2D)

• observations

• conclusion

Demographic and other data

• Age and gender, heart rate and rhythm are essential.

• Height, weight and BSA are ideal and essential when indexing volumes and EOA.

• Blood pressure is ideal when interpreting load-dependent quantities (e.g. MR, AR or LV ejection fraction) and in patients with LV hypertrophy or other signs potentially seen in long-standing hypertension (e.g. aortic or LA dilatation).

• Include indications for the test.

Measurements

• Measured intracardiac dimensions are used to:

• diagnose pathology (e.g. dilated cardiomyopathy)

• aid quantification of an abnormality (e.g. LV dilatation in chronic aortic regurgitation)

• determine treatment (e.g. surgery for asymptomatic severe aortic regurgitation if systolic LV diameter >50 mm)

• monitor disease progression.

• They may need to be interpreted in the light of the size and sex of the patient. Many pragmatic normal ranges are outdated and modern data based on large populations include upper dimensions previously regarded as abnormal (see Chapter 2).

Observations

• These should be in sufficient detail to allow another echocardiographer to visualise your study.

• All parts of the heart and great vessels should be described. If it was not possible to image a region, this should be stated. This gives the reader the confidence that a systematic study has been undertaken rather than a study focused on only a limited region of interest.

• Preliminary interpretation can be included where it aids understanding (e.g. ‘rheumatic mitral valve’). The grade of stenosis or regurgitation can also be included provided the observations used to make the judgement are also included or available in the measurement section.

• No consensus exists about reporting minor abnormalities (e.g. mild mitral annulus calcification), normal variants (e.g. chiari net) or normal findings (e.g. trivial mitral regurgitation). We suggest describing these in the text but omitting them...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Acknowledgements
• Author biographies
• Icons and QR codes
• Abbreviations
• 1 Introduction
• 2 Left ventricular dimensions and function
• 3 Acute coronary syndrome
• 4 Cardiomyopathies
• 5 The right ventricle
• 6 Pulmonary pressure and hypertension
• 7 Aortic valve disease
• 8 Mitral valve disease
• 9 Right-sided valve disease
• 10 Replacement heart valves
• 11 Endocarditis
• 12 The aorta and dissection
• 13 The atria and atrial septum
• 14 Adult congenital disease
• 15 Pericardial disease
• 16 Masses
• 17 Echocardiography in acute and critical care medicine
• 18 General clinical requests
• 19 Indications and appropriateness criteria for echocardiography
• Appendices