ECHOCARDIOGRAPHY REPORT

EXAM: Transthoracic Echocardiogram (Complete)
DATE OF EXAM: 01/07/2026
ORDERING PHYSICIAN: Dr. Amanda Foster, Internal Medicine
SONOGRAPHER: Karen Liu, RDCS
INTERPRETING PHYSICIAN: Dr. David Nakamura, Cardiology

PATIENT: Smith, Jane A.
MRN: 00-44-7831
DOB: 04/17/1958

INDICATION: Acute decompensated heart failure, HFrEF. Reassess left ventricular function and valvular status. Prior LVEF 35% (06/2025).

TECHNICAL QUALITY: Adequate. Limited by body habitus.

MEASUREMENTS:
Left Ventricle:
  LV Internal Diameter, Diastole (LVIDd): 6.2 cm (normal <5.6 cm) -- dilated
  LV Internal Diameter, Systole (LVIDs): 5.1 cm
  Interventricular Septum, Diastole (IVSd): 1.0 cm (normal)
  LV Posterior Wall, Diastole (LVPWd): 0.9 cm (normal)
  Left Ventricular Ejection Fraction (LVEF): 30-35% (reduced, previously 35%)
  Global longitudinal strain (GLS): -10.2% (abnormal, normal < -18%)
  LV mass index: 128 g/m2 (mildly increased)

Left Atrium:
  LA Volume Index: 42 mL/m2 (moderately dilated, normal <34 mL/m2)

Right Ventricle:
  RV Basal Diameter: 4.1 cm (mildly dilated)
  TAPSE: 1.5 cm (borderline reduced, normal >1.7 cm)

Right Atrium:
  RA area: 22 cm2 (mildly dilated)

Aortic Root: 3.2 cm (normal)
Ascending Aorta: 3.4 cm (normal)

VALVULAR ASSESSMENT:

Aortic Valve: Trileaflet. Mild sclerosis without significant stenosis. No aortic regurgitation. Peak velocity 1.4 m/s, mean gradient 6 mmHg.

Mitral Valve: Leaflets are mildly thickened. Moderate mitral regurgitation (MR) by color Doppler, with a central jet. Vena contracta 0.5 cm. Regurgitant volume estimated at 35 mL. MR appears functional (secondary) due to annular dilatation and LV remodeling.

Tricuspid Valve: Mild tricuspid regurgitation. Estimated RVSP 48 mmHg (elevated, indicating mild pulmonary hypertension), assuming RAP of 10 mmHg based on IVC diameter of 2.3 cm with <50% inspiratory collapse.

Pulmonic Valve: Normal. No stenosis or significant regurgitation.

DOPPLER FINDINGS:
Mitral inflow: E/A ratio 2.1 (restrictive filling pattern). Deceleration time 140 ms (shortened).
Tissue Doppler: Medial e' 4 cm/s, lateral e' 6 cm/s. E/e' ratio (average) 21 -- consistent with elevated LV filling pressures (Grade III diastolic dysfunction).

PERICARDIUM: No pericardial effusion.

OTHER: Bilateral pleural effusions noted, left greater than right. IVC is dilated at 2.3 cm with reduced respiratory variation (<50% collapse), consistent with elevated right atrial pressure.

WALL MOTION:
Global LV hypokinesis. Regional wall motion abnormalities noted with akinesis of the inferior and infero-septal walls (basal and mid segments), consistent with prior inferior myocardial infarction territory. Remaining segments are diffusely hypokinetic.

IMPRESSION:
1. Severely reduced left ventricular systolic function with LVEF 30-35%, mildly decreased from prior (35% in 06/2025). Global hypokinesis with regional akinesis of the inferior and infero-septal walls consistent with known ischemic cardiomyopathy.
2. LV cavity dilation (LVIDd 6.2 cm). Moderately dilated left atrium.
3. Moderate functional (secondary) mitral regurgitation.
4. Elevated estimated RVSP of 48 mmHg suggesting mild pulmonary hypertension, likely secondary to left heart disease.
5. Grade III (restrictive) diastolic dysfunction with elevated filling pressures (E/e' 21).
6. Dilated IVC with reduced inspiratory collapse, consistent with elevated right atrial pressure and clinical volume overload.
7. Bilateral pleural effusions.

REPORTED BY: Dr. David Nakamura, MD, FACC
