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What Does This Echo Report Indicate?
Question: What does it mean on an echo when it says" Respirophasic changes were blunted (less than 50% variation)" and what does it mean when Left ventricle systolic function "was vigorous by visual assessment?"
I forgot to mention-the respirophasic changes was under the inferior vena cava report
I forgot to mention-the respirophasic changes was under the inferior vena cava report
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully read your question and would explain that respirophasic changes of inferior vena cava means that increased systemic venous pressure may be present, especially if there is also dilation of inferior vena cava.
In such case it is necessary to measure pulmonary artery systolic pressure.
If PASP is abnormally increased then a differential diagnosis should be done (probable disorder of pulmonary blood circulation or anz degree of left ventricular dysfunction).
If PSAP is normal, then those respirophasic findings are not clinically relevant.
I would like to directly review your ECHO reports for another professional opinion.
Could you please upload it here for me to review?
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I carefully read your question and would explain that respirophasic changes of inferior vena cava means that increased systemic venous pressure may be present, especially if there is also dilation of inferior vena cava.
In such case it is necessary to measure pulmonary artery systolic pressure.
If PASP is abnormally increased then a differential diagnosis should be done (probable disorder of pulmonary blood circulation or anz degree of left ventricular dysfunction).
If PSAP is normal, then those respirophasic findings are not clinically relevant.
I would like to directly review your ECHO reports for another professional opinion.
Could you please upload it here for me to review?
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry but I am not able to upload the ECHO report separately, so I had to type it out.
Left ventricle: Systolic function was vigorous by visual assessment.
Ejection fraction was estimated be 65%. Although no diagnostic regional wall motion abnormality was identified, this possibility cannot be completely excluded on the basis of this study. Wall thickness was normal.
Doppler: Left ventricular diastolic function parameters were normal.
Aortic valve: The valve was trileaflet. Leaflets exhibited normal thickness and normal cuspal separation. The valve was not well visualized.
Doppler: Transaortic velocity was within the normal range. There was no evidence for stenosis. There was no aortic regurgitation.
Aorta: The root exhibited normal size
Mitral Valve: Valve structure was normal. There was normal leaflet separation.
Doppler: The transmitral velocity was within the normal range. There was no evidence for stenosis. There was no mitral regurgitation.
Left atrium: Size was normal.
Right ventricle: The size was normal. Systolic function was normal.
Pulmonic Valve: Leaflets exhibited normal thickness, no calcifications, and normal cuspal separation.
Doppler: The transpulmonic velocity was within the normal range. There was no pulmonic regurgitation
Tricuspid Valve: The valve structure was normal
Doppler: There was no tricuspid regurgitation.
Right ventricle: Systolic function was normal.
Pericardium: There was no pericardial effusion
Inferior vena cava, hepatic veins: Respirophasic changes were blunted (less than 50% variation)
Right atrium: Size was normal
Systemic veins: The IVC was normal in size. Respirophasic changes were blunted (less than 50% variation)
2D Measurements
Left ventricle (reference normals)
LVI ed, base, PLAX 43mm
LVPW thickness ed 6mm
Ratio IVS/LVPW 1.17
Ventricular septum
IVS thickness ed 7mm
Aorta
Root XXXXXXX diam-sinus valsalva ed 28 mm
Left Atrium
AP dim 30 mm
Doppler Measurements
Left Ventricle
EA lat XXXXXXX tiss DP 19 cm/s
E/Ea lat XXXXXXX tiss DP 4.05
Aa, lat nn, tiss DP 9cm/s
EA, med XXXXXXX tiss DP 12 cm/s
E/Ea med XXXXXXX tiss DP 6.42
Aa med XXXXXXX tiss DP 7cm/s
Mitral Valve
Peak E vel 77 cm/s
Peak A vel 68 cm/s
Peak E/A ratio 1.13
Estimated CVP 8mmHg
I have had shortness of breath for over a year. Worse with exertion. Really bad when going upstairs. I feel so much better when I lay flat. I had other echos but they wanted it repeated because when I did my stress test my blood pressure response was flat. I had pulmonary function tests and they were ok except for a low DLCO. My doctor had mentioned ruling out pulmonary hypertension. I have not seen my doctor to review this echo yet. Also on another echo it had said a minimal left to right interatrial shunt, but I don't see anything mentioned about it on this echo. What increases systemic venous pressure?
Left ventricle: Systolic function was vigorous by visual assessment.
Ejection fraction was estimated be 65%. Although no diagnostic regional wall motion abnormality was identified, this possibility cannot be completely excluded on the basis of this study. Wall thickness was normal.
Doppler: Left ventricular diastolic function parameters were normal.
Aortic valve: The valve was trileaflet. Leaflets exhibited normal thickness and normal cuspal separation. The valve was not well visualized.
Doppler: Transaortic velocity was within the normal range. There was no evidence for stenosis. There was no aortic regurgitation.
Aorta: The root exhibited normal size
Mitral Valve: Valve structure was normal. There was normal leaflet separation.
Doppler: The transmitral velocity was within the normal range. There was no evidence for stenosis. There was no mitral regurgitation.
Left atrium: Size was normal.
Right ventricle: The size was normal. Systolic function was normal.
Pulmonic Valve: Leaflets exhibited normal thickness, no calcifications, and normal cuspal separation.
Doppler: The transpulmonic velocity was within the normal range. There was no pulmonic regurgitation
Tricuspid Valve: The valve structure was normal
Doppler: There was no tricuspid regurgitation.
Right ventricle: Systolic function was normal.
Pericardium: There was no pericardial effusion
Inferior vena cava, hepatic veins: Respirophasic changes were blunted (less than 50% variation)
Right atrium: Size was normal
Systemic veins: The IVC was normal in size. Respirophasic changes were blunted (less than 50% variation)
2D Measurements
Left ventricle (reference normals)
LVI ed, base, PLAX 43mm
LVPW thickness ed 6mm
Ratio IVS/LVPW 1.17
Ventricular septum
IVS thickness ed 7mm
Aorta
Root XXXXXXX diam-sinus valsalva ed 28 mm
Left Atrium
AP dim 30 mm
Doppler Measurements
Left Ventricle
EA lat XXXXXXX tiss DP 19 cm/s
E/Ea lat XXXXXXX tiss DP 4.05
Aa, lat nn, tiss DP 9cm/s
EA, med XXXXXXX tiss DP 12 cm/s
E/Ea med XXXXXXX tiss DP 6.42
Aa med XXXXXXX tiss DP 7cm/s
Mitral Valve
Peak E vel 77 cm/s
Peak A vel 68 cm/s
Peak E/A ratio 1.13
Estimated CVP 8mmHg
I have had shortness of breath for over a year. Worse with exertion. Really bad when going upstairs. I feel so much better when I lay flat. I had other echos but they wanted it repeated because when I did my stress test my blood pressure response was flat. I had pulmonary function tests and they were ok except for a low DLCO. My doctor had mentioned ruling out pulmonary hypertension. I have not seen my doctor to review this echo yet. Also on another echo it had said a minimal left to right interatrial shunt, but I don't see anything mentioned about it on this echo. What increases systemic venous pressure?
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again,
I carefully reviewed your actual ECHO report and considering what is written I would explain that cardiac structure and function seem to be perfectly normal (no evidence of cardiomyopathy, no systolic or diastolic dysfunction, no valvular disorders, no evidence of pulmonary hypertension, no left-to-right intra-cardiac shunt).
Nevertheless, though there is no any causative correlation between your actual cardiac ECHO and those blunted respirophasic changes, based on the previous echo findings of a minimal inter-atrial shunt, especially considering your recent history of shortness of breathing it is necessary to further investigate about possible reasons of your clinical symptomatology.
There are several reasons, why you have that pattern of dyspnea (exacerbated on physical activity and upright position and relieved when lying down, generally called platypnea).
Platypnea may be related to an anatomical cardiac defect (such as inter-atrial shunting), but may also be an indicator of other reasons, like hepato-pulmonary syndrome, as well.
Several pulmonary circulatory disorders may lead to low DLCO and clinical scenario of dyspnea.
Another disorder, associated with venous blood return from portal vein to inferior vena cava excluding intra-hepatic circulation, may lead to your actual symptomatology.
Coming to this point, I would recommend discussing with your attending physician for further diagnostic investigations, in order to rule in/out the above mentioned disorders.
A trans-esophageal cardiac ECHO is necessary to investigate for a possible cardiac shunt.
Also, abdominal angio CT would be helpful to clarify the underlying venous blood circulation.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again,
I carefully reviewed your actual ECHO report and considering what is written I would explain that cardiac structure and function seem to be perfectly normal (no evidence of cardiomyopathy, no systolic or diastolic dysfunction, no valvular disorders, no evidence of pulmonary hypertension, no left-to-right intra-cardiac shunt).
Nevertheless, though there is no any causative correlation between your actual cardiac ECHO and those blunted respirophasic changes, based on the previous echo findings of a minimal inter-atrial shunt, especially considering your recent history of shortness of breathing it is necessary to further investigate about possible reasons of your clinical symptomatology.
There are several reasons, why you have that pattern of dyspnea (exacerbated on physical activity and upright position and relieved when lying down, generally called platypnea).
Platypnea may be related to an anatomical cardiac defect (such as inter-atrial shunting), but may also be an indicator of other reasons, like hepato-pulmonary syndrome, as well.
Several pulmonary circulatory disorders may lead to low DLCO and clinical scenario of dyspnea.
Another disorder, associated with venous blood return from portal vein to inferior vena cava excluding intra-hepatic circulation, may lead to your actual symptomatology.
Coming to this point, I would recommend discussing with your attending physician for further diagnostic investigations, in order to rule in/out the above mentioned disorders.
A trans-esophageal cardiac ECHO is necessary to investigate for a possible cardiac shunt.
Also, abdominal angio CT would be helpful to clarify the underlying venous blood circulation.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for all of your thorough explanations. Just a couple more quick questions.
What exactly does blunted respirophasic changes mean? Does this have to do with IVC collapse ?
What would the disorder be that is associated with venous blood return from the portal vein to IVC? (Other than hepato-pulmonary syndrome)
Does a flat blood pressure response correlate to any of these conditions
It seems like a lot of these things would be congenital defects but I don't understand why they are only presenting in the past year and I am 34 years old.
I am scheduled to get an exercise right heart XXXXXXX at the end of the month.
What exactly does blunted respirophasic changes mean? Does this have to do with IVC collapse ?
What would the disorder be that is associated with venous blood return from the portal vein to IVC? (Other than hepato-pulmonary syndrome)
Does a flat blood pressure response correlate to any of these conditions
It seems like a lot of these things would be congenital defects but I don't understand why they are only presenting in the past year and I am 34 years old.
I am scheduled to get an exercise right heart XXXXXXX at the end of the month.
Brief Answer:
I would explain:
Detailed Answer:
Hello!
Let me explain that normally during inspiration IVC shows a collapse more that 50% of its diameter.
This is explained from generation of negative pressure and increased blood return inside the thorax during inspiration.
You are right: respirophasic changes means IVC collapsibility.
When IVC collapsibility is decreased, this may be a sign of a disordered venous blood return toward the right heart.
As there are several reasons why this happens, it is necessary for further clinical investigations (as I explained you above).
Regarding your question on hepato-pulmonary syndrome. I would explain that in such case liver dysfunction may lead to abnormal production of some mediators (ex. NO., etc.) and subsequent pulmonary blood circulation implication.
The resulting effect in pulmonary microcirculation will lead in pulmonary blood vessel dilation and rapid or direct passage of mixed venous blood into the pulmonary veins.
The result is decreased blood oxygenation and signs of breathlessness (with mainly platypnea).
Whereas, abnormal portal vein drainage to IVC is a rare condition called Abernethy malformation and denotes a direct blood shunting from portal vein to IVC, renal veins or iliac veins excluding intra-hepatic blood circulation.
The above disorders may lead to your recent clinical scenario (difficulty breathing and low DLCO).
But before considering these rare options, I would recommend investigating for the previously echo detected inter-atrial shunt.
Trans-esophageal cardiac echo is an optimal strategy for this investigation.
Also right heart catheterization is an optimal way for such purpose.
Hope you will find this answer helpful!
Regards,
Dr. Iliri
I would explain:
Detailed Answer:
Hello!
Let me explain that normally during inspiration IVC shows a collapse more that 50% of its diameter.
This is explained from generation of negative pressure and increased blood return inside the thorax during inspiration.
You are right: respirophasic changes means IVC collapsibility.
When IVC collapsibility is decreased, this may be a sign of a disordered venous blood return toward the right heart.
As there are several reasons why this happens, it is necessary for further clinical investigations (as I explained you above).
Regarding your question on hepato-pulmonary syndrome. I would explain that in such case liver dysfunction may lead to abnormal production of some mediators (ex. NO., etc.) and subsequent pulmonary blood circulation implication.
The resulting effect in pulmonary microcirculation will lead in pulmonary blood vessel dilation and rapid or direct passage of mixed venous blood into the pulmonary veins.
The result is decreased blood oxygenation and signs of breathlessness (with mainly platypnea).
Whereas, abnormal portal vein drainage to IVC is a rare condition called Abernethy malformation and denotes a direct blood shunting from portal vein to IVC, renal veins or iliac veins excluding intra-hepatic blood circulation.
The above disorders may lead to your recent clinical scenario (difficulty breathing and low DLCO).
But before considering these rare options, I would recommend investigating for the previously echo detected inter-atrial shunt.
Trans-esophageal cardiac echo is an optimal strategy for this investigation.
Also right heart catheterization is an optimal way for such purpose.
Hope you will find this answer helpful!
Regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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