Understand echocardiogram reports and protect heart health

Author: Wan Linyuan, deputy chief physician of Fuwai Hospital, Chinese Academy of Medical Sciences

Li Muzi, deputy chief physician, Fuwai Hospital, Chinese Academy of Medical Sciences

Zhang Jiaqi Chief Technician, Fuwai Hospital, Chinese Academy of Medical Sciences

Zhang Tingting, attending physician at the Fuwai Hospital of the Chinese Academy of Medical Sciences

Reviewer: Wang Hao, Chief Physician and Professor, Fuwai Hospital, Chinese Academy of Medical Sciences

When it comes to echocardiography, perhaps friends may find this term a little unfamiliar. Have you heard of the terms "heart B-ultrasound" and "heart ultrasound"? Yes, they all refer to echocardiography. After completing an echocardiogram or "heart ultrasound", the doctor usually provides an A4 paper report with numbers, tables, and a series of seemingly "obscure" professional terms. Does this make you feel confused? Today, we will reveal this mystery to you: What information does the heart ultrasound report tell you?

First, let's take a look at this ultrasound report:

Figure 1 Copyright image, no permission to reprint

As marked in the figure, in addition to the patient's basic information, a cardiac ultrasound report mainly contains two parts of information: the results of the echocardiogram and the final summary statement. The results part can be further divided into the specific values ​​measured by the ultrasound and the detailed text description of the ultrasound findings. Feeling a little confused again? Don't worry, we will analyze them one by one.

1. What does the inspection observe?

First, let's look at the specific requirements for observation and measurement required for an ultrasound examination in the American Society of Echocardiography's Recommendations 1 on Quality Control of Echocardiography Laboratory Work:

Figure 2 Copyright image, no permission to reprint

Each item listed in the table represents a basic structure of the heart. If the heart is compared to a house with four large rooms, then the structures in the table are equivalent to the rooms, doors, pipes and walls of the house.

The left ventricle, left atrium, right atrium, and right ventricle are the four rooms of the house. During the examination, the doctor will accurately measure the size of each room, evaluate the thickness of the room walls (such as the ventricular septum, left ventricular wall, and right ventricular wall), and carefully observe whether the walls are damaged. The heart is an organ that pumps blood, and the contraction and relaxation functions of each "chamber" are crucial. Therefore, the examination will also pay special attention to the contraction and relaxation capabilities of the left ventricle and right ventricle. The contraction function of the left ventricle is evaluated by the ejection fraction (EF), while the contraction function of the right ventricle is measured by indicators such as tricuspid anulunar plane systolic excursion (TAPSE) and pulsed Doppler tricuspid anulunar plane systolic peak velocity (s').

The aortic valve, mitral valve, tricuspid valve, and pulmonary valve are the four important doors of this house, and they are all one-way doors. This means that when the blood in the heart passes through these valves, it can only flow in a specific direction, that is, "forward blood flow." If reverse flow occurs, it is called "regurgitation." During the examination, the doctor will carefully observe whether the morphology of these four valves is normal and measure the speed of their forward blood flow. As for the "pressure difference" value to the right of the "flow velocity" value in the table, it is calculated according to a specific formula (pressure difference = 4×flow velocity 2).

The pericardium, as a double-layer structure wrapped around the outer layer of the heart, is similar to the two layers of "skin" on the outside of a house - the visceral pericardium is close to the surface of the heart, and the parietal pericardium is wrapped around the outside. Under normal circumstances, there is a small amount of lubricating fluid between the two. If the amount of fluid increases significantly, it is diagnosed as "pericardial effusion". When the pericardium is diseased, the two layers of "skin" may thicken, adhere, and even increase the effusion or form a mass.

The aorta, pulmonary artery, inferior vena cava, and pulmonary vein constitute the main pipeline system of the heart. The examination will confirm whether these pipelines exist, whether they are connected to the correct position, whether the inner diameter is normal, and whether there is any expansion or stenosis. In addition, there are some smaller pipelines in the heart house, including the coronary artery and coronary sinus, and the doctor will also carefully check whether they are normal.

The atrial septum and ventricular septum, as the walls of a house, separate the two atria and two ventricles respectively. During the examination, the doctor will pay special attention to whether the positions of these two walls are offset and whether there are gaps. If there is a gap, the doctor will further measure the size of the gap, describe its location, and measure the blood flow rate through the gap.

Finally, if there are abnormal tubes or gaps in the heart, the doctor will carefully measure their size and blood flow rate to ensure a comprehensive assessment of the heart structure.

2. What does ultrasound findings include?

After understanding the key points of ultrasound examination observation, it will be much easier for us to understand the text description of "ultrasound findings". Ultrasound findings are generally divided into two parts: two-dimensional images and Doppler examination findings. It can be understood that one part describes the structure of the heart and the other part describes the dynamics of blood flow in the heart.

In the part describing the structure of the heart, the size of the atria and ventricles, the thickness of the ventricular walls, whether the ventricular movement is coordinated, and whether the ventricular contraction function is normal will be described in turn; at the same time, the structural changes of the valves will be described, and whether these structural changes have led to abnormal valve function, such as stenosis (cannot open) or regurgitation (cannot close); in addition, the position and size of the heart's large blood vessels will be described, whether there are abnormalities, and whether there are lesions in the pericardium. If there are abnormal channels between the heart chambers, they will also be recorded in detail. Of course, if abnormal substances are found in the heart, such as blood clots, tumors, inflammatory vegetations, etc., they will also be carefully marked by the doctor.

In the part describing the dynamics of blood flow in the heart, it will be described whether the forward blood flow velocity of each valve is within the normal range. Accelerated blood flow may indicate valve stenosis or excessive blood flowing through the valve. At the same time, it will also describe whether there is valve regurgitation and its degree. By measuring the regurgitation velocity of the tricuspid valve and the pulmonary valve, the level of pulmonary artery pressure can also be indirectly inferred.

3. Interpretation of ultrasound impressions?

Ultrasound impression is a summary of the heart disease made by the ultrasound doctor based on the findings of the entire examination, and can also be regarded as the ultrasound doctor's diagnostic opinion. For cases with a clear diagnosis, the ultrasound impression will first "get straight to the point" and clearly point out the specific heart disease in the first one or two lines, and then list the lesions in detail according to the classification of structure, stenosis/reflux, function, etc. For cases where the diagnosis is not yet clear, the ultrasound impression will list the abnormalities found one by one according to the severity of the lesion and the structure and function.

An echocardiogram report, although just a thin piece of paper, contains such rich examination information in just a few words. Isn't it amazing? Now, let's use the knowledge we have just learned to try to interpret the ultrasound report!

References

[1] Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, Keller AM, Malenka DJ, Masoudi FA, McCulloch M, Pellikka PA, Peters PJ, Stainback RF, Strachan GM, Zoghbi WA; American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011 Jan;24(1):1-10. doi: 10.1016/j.echo.2010.11.006. PMID: 21172594.