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Please Review The Echo Reports And Advise If The Reports Are Normal
Question: I am a 62 years male with hypertension & IGA nephropathy for the past 12 years which is being treated with Cardace 10 mg, Stamlo 5 mg, Lipitor 10 mg, and fish oil capsules. In addition I have a benign prostrate (Grade 2) since July 2016- tablet urimax 0.40 mg since April 22, and multiple thyroid nodules (largest on left & right side each 0.81mm x 0.50 cm, no medication). BP is around 130/80. My height is 164 cm and weight 62 kg.
I attach my latest Echo report of August 2022 and my previous Echo in July 2019. My queries on the Echo are as follows:
1. Please review the Echo reports and advise if the reports are normal.
2. The Echo report does not mention the reference ranges for the various dimensions. What are the reference values used by labs for the following : LVID(ed), LVID(es), LVPW (ed & es), IVS (ed & es).
3. My LVID(ed) was 4.7 cm in July 2019 and increased to 5.1 cm in August 2022. Similarly my EDV increased from 103.1 mm to 124.9 mm. Is this a cause for concern? What could be the reason for such an increase?
4. Is there any reason why BSA indexed Echo results are not used by labs when reporting Echo results? My BSA works out to 1.68 (height 164 cm and weight 62 kg). Based on this I am above the normal range for LVIDd and EDV. If my weight increased to say 68 kg, my BSA would be 1.76, and my LVIDd and EDV would be within the indexed reference values- this intuitively does not seem sensible. Could you please explain how BSE indexed values can be calculated for my Echo dimensions for LVIDd and EDV?
5. What steps can be taken to improve a high LVID ? I would like to reduce the LVIDd from 5.1 cm.
Thanks
I attach my latest Echo report of August 2022 and my previous Echo in July 2019. My queries on the Echo are as follows:
1. Please review the Echo reports and advise if the reports are normal.
2. The Echo report does not mention the reference ranges for the various dimensions. What are the reference values used by labs for the following : LVID(ed), LVID(es), LVPW (ed & es), IVS (ed & es).
3. My LVID(ed) was 4.7 cm in July 2019 and increased to 5.1 cm in August 2022. Similarly my EDV increased from 103.1 mm to 124.9 mm. Is this a cause for concern? What could be the reason for such an increase?
4. Is there any reason why BSA indexed Echo results are not used by labs when reporting Echo results? My BSA works out to 1.68 (height 164 cm and weight 62 kg). Based on this I am above the normal range for LVIDd and EDV. If my weight increased to say 68 kg, my BSA would be 1.76, and my LVIDd and EDV would be within the indexed reference values- this intuitively does not seem sensible. Could you please explain how BSE indexed values can be calculated for my Echo dimensions for LVIDd and EDV?
5. What steps can be taken to improve a high LVID ? I would like to reduce the LVIDd from 5.1 cm.
Thanks
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
Both your reports are within normal ranges.
I think that these changes in your cardiac ultrasound are related to inter- observer variability ( which means the machine properties and technician measurements).
The normal range for LVIDd is 3.5-5.6 cm, and the normal range for LVIDs is 2.0-4.0 cm.
LVPWd and LVPWs – Left ventricular posterior wall end diastole and end systole. The normal range is 0.6-1.1 cm.
IVSd and IVSs – Interventricular septal end diastole and end systole. The normal range is 0.6-1.1 cm.
There is no reason to panic!
There is no reason to change anything!
Hope you will find this information helpful!
Kind regards,
Dr. Ilir Sharka, cardiologist
I would explain as follows:
Detailed Answer:
Hello,
Both your reports are within normal ranges.
I think that these changes in your cardiac ultrasound are related to inter- observer variability ( which means the machine properties and technician measurements).
The normal range for LVIDd is 3.5-5.6 cm, and the normal range for LVIDs is 2.0-4.0 cm.
LVPWd and LVPWs – Left ventricular posterior wall end diastole and end systole. The normal range is 0.6-1.1 cm.
IVSd and IVSs – Interventricular septal end diastole and end systole. The normal range is 0.6-1.1 cm.
There is no reason to panic!
There is no reason to change anything!
Hope you will find this information helpful!
Kind regards,
Dr. Ilir Sharka, cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your prompt and reassuring responses. A few follow up questions :
1. My LVID(ed) was 4.7 cm in July 2019, and 5.1 cm in August 2022. Similarly EDV was 103.1 mm in July 2019, and 124.9 mm in August 2022. My exercise intensity was a bit more during the past 3 years (March 2020 onwards) resulting in reduction in weight from 66 kg to 62 kg. Although the higher LVIDd and EDV values are still within range, and inter observer variabiity could be a reason (however I used the same lab, same technician), could more intense exercise cause higher LVIDd dimensions?
2. If the change in my LVID(ed) and EDV is not due to inter observer variability, what could be the reason for the increase ? Is this increase considered significant when a cardiologist reviews these echo results (July 19 and Aug 22) for a patient?
3. I am repeating this question on BSA for ease of reference: Is there any reason why BSA indexed Echo results are not used by labs when reporting Echo results?
My BSA works out to 1.68 (height 164 cm and weight 62 kg). Based on this, I am above the normal range for LVIDd and EDV. If my weight increased to say 68 kg, my BSA would be 1.76, and my LVIDd and EDV would be within the indexed reference values- this intuitively does not seem sensible. Could you please explain how BSE indexed values can be calculated for my Echo dimensions for LVIDd and EDV?
4. Even if my LVIDd is within range, what steps can be taken to improve a high LVIDd ? I would like to reduce my LVIDd from its current 5.1 cm.
My apologies in advance for these questions, and thank you for your prompt and informative earlier responses.
1. My LVID(ed) was 4.7 cm in July 2019, and 5.1 cm in August 2022. Similarly EDV was 103.1 mm in July 2019, and 124.9 mm in August 2022. My exercise intensity was a bit more during the past 3 years (March 2020 onwards) resulting in reduction in weight from 66 kg to 62 kg. Although the higher LVIDd and EDV values are still within range, and inter observer variabiity could be a reason (however I used the same lab, same technician), could more intense exercise cause higher LVIDd dimensions?
2. If the change in my LVID(ed) and EDV is not due to inter observer variability, what could be the reason for the increase ? Is this increase considered significant when a cardiologist reviews these echo results (July 19 and Aug 22) for a patient?
3. I am repeating this question on BSA for ease of reference: Is there any reason why BSA indexed Echo results are not used by labs when reporting Echo results?
My BSA works out to 1.68 (height 164 cm and weight 62 kg). Based on this, I am above the normal range for LVIDd and EDV. If my weight increased to say 68 kg, my BSA would be 1.76, and my LVIDd and EDV would be within the indexed reference values- this intuitively does not seem sensible. Could you please explain how BSE indexed values can be calculated for my Echo dimensions for LVIDd and EDV?
4. Even if my LVIDd is within range, what steps can be taken to improve a high LVIDd ? I would like to reduce my LVIDd from its current 5.1 cm.
My apologies in advance for these questions, and thank you for your prompt and informative earlier responses.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
I understand your concern and I still think that there is nothing concerning with your cardiac ultrasound reports. Here are my answers to your questions:
The increase in LVID is not significant and I don't think that it is related to the increased physical activity, considering the short period of time between the two cardiac ultrasounds. Straining physical activity may lead to myocardial muscle hypertrophy, but you should know that the cardiac chambers modulations in response to physical activity need a prolonged period of time to occur. So, I don't think that this is your case.
I still think that this is inter observer variability.
The BSA indexet echo results are not usually used in non obese or overweight persons. Here is an article you can read on this topic: https://www.nature.com/articles/jhh200916.
There is no way to decrease LVIDd in a healthy patient. I would just encourage you to follow a healthy lifestyle (regular physical activity, a healthy diet and avoid alcohol or smoking).
Considering your anxiety, I would recommend follow up with another cardiac ultrasound in six months. If there are still uncertainties, I would recommend performing a cardiac MRI, which would be a more accurate test to examine better the cardiac chambers volume, function, structure and myocardial tissue characterization.
Hope you will find this information helpful!
Wishing all the best,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
I understand your concern and I still think that there is nothing concerning with your cardiac ultrasound reports. Here are my answers to your questions:
The increase in LVID is not significant and I don't think that it is related to the increased physical activity, considering the short period of time between the two cardiac ultrasounds. Straining physical activity may lead to myocardial muscle hypertrophy, but you should know that the cardiac chambers modulations in response to physical activity need a prolonged period of time to occur. So, I don't think that this is your case.
I still think that this is inter observer variability.
The BSA indexet echo results are not usually used in non obese or overweight persons. Here is an article you can read on this topic: https://www.nature.com/articles/jhh200916.
There is no way to decrease LVIDd in a healthy patient. I would just encourage you to follow a healthy lifestyle (regular physical activity, a healthy diet and avoid alcohol or smoking).
Considering your anxiety, I would recommend follow up with another cardiac ultrasound in six months. If there are still uncertainties, I would recommend performing a cardiac MRI, which would be a more accurate test to examine better the cardiac chambers volume, function, structure and myocardial tissue characterization.
Hope you will find this information helpful!
Wishing all the best,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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