Echo and stress results interpretation - extremely worried someone please help!

[Dentalmaniac]

Echocardiogram (done in July 2010, a month before stress echo)
Dimensions:
IVSd: 1.17 cm
LVDd:3.71 cm
LVDind:2.55 cm/m2
LVPWd:0.76 cm
LVDs:2.49cm
AO RTd:2.34 cm
AO RTind: 1.61cm/m2
LADd:3.15 cm
LADind: 2.16cm/m2
Teich EF: 62%
Vol EF: 62%
LV FS: 33%
LV Mass Index: 74g/m2
Aortic Valve:
Max vel: 1.93 m/sec
VTI: 37.2mmHG
Peak PG: 14.9mmHG
Mean PG: 6.9mmHG
Mitral Valve:
E Max: 1.23 m/sec
A Max: 0.68m/sec
E/A: 1.81
MR Peak PG: 10.3mmHG
Tricuspid Valve:
TR Max: 1.46m/sec
RSVP: 18.5mmHG
Pulmonic Valve:
Mean PG: mmHG
Peak PG: 4.8 mmHg
Pulmonary Veins
IVC
LVOT
Findings Summary:
A complete two dimensional transthoracic echocardiogram is performed (2D M mode Doppler and color flow Doppler). The study is technically adequate.
Left Ventricle: Normal size and function. Mild concentric left ventricular hypertrophy
Right Ventricle: Normal size and function
Left Atrium: normal
Right Atrium: normal
Tricuspid valve: Trace tricuspid regurgitation
Aortic valve: normal
Pulmonic valve: normal
Pericardium: normal. No pericardial effusion
Physician conclusions:
Normal ventricle size and function. Mild concentric left ventricular hypertrophy
Stress echocardiography report (done in august 2010):
The patient excercised 11.4 minutes on the treadmill using the bruce protocol, attaining 112% of maximal predicted heart rate. The test was stopped primarily due to fatigue and secondarily due to attainment target heart rate. The patient did not experience chest pain during stress testing. The resting ecg revealed sinus rhythm with normal conduction and non-specific ST-T wave changes. The stress electrocardiogram was negative for ischemia. Occasional PVCs were seen. The calculated Duke Treadmill Score was 11.4 indicating a low risk of future cardiac events.
Imgaging data: Wall motion
Post Stress: EF%: 70-75
Rest: EF%: 60-65
Stress Echo Conclusions:
Normal Study. No evidence of ischemia or infarction
Resting Echocardiogram findings:
1. Normal resting left ventricular size, estimated EF 60-65%. No resting regional wall motion abnormalities noted.
2. Aortic valve sclerosis. No evidence of aortic stenosis or insufficiency.
3. Thickened mitral leaflets.
4. Structurally and functionally unremarkable tricuspid and pulmonic valves.
40 year old female, weigh 112 pounds. Am paranoid about my heart health. The doctor’s only comments after these tests were they’re normal. Got these tests done a year ago and just picked up the reports from the doctors’ office. Also never have had high blood pressure. Cholesterol has always been under 200, however in a recent test done a month ago, the total was 214 so slightly above normal range
My question is how to interpret the two results; echo and stress echo. The echo that was done a month before stress echo says there’s mild concentric left ventricular hypertrophy and does not mention anything about aortic valve sclerosis, infact says normal aortic valve. The stress echo done a month later does not mention the mild concentric LVH, infact says normal resting left ventricular size, however does say Aortic valve sclerosis. I’m surprised that the doctor did not mention Aortic Valve Sclerosis or the mild LVH, when all I’ve read so far is this could be pre cursor to CAD and therefore needs to be watched. I’m surprised nothing regarding this was mentioned to me by the doctor.
Do I need to be concerned with these results. Are these results a pre cursor for bigger problems to come. Would appreciate someone’s expert advice as I’m so so worried ever since I saw these. The more I read the more I feel i am too young to have mild concentric LVH and Aortic valve sclerosis, as these are seen in people over 65....can someone give their expert opinion and put my mind to rest!

[Sadhan2]

Bicuspid aortic valve oblique closure line. No haemodynamically insignificant as or ar, normal left ventricular functions. Sinus rhythm during study. can anybody please explain this impression?

[kenkeith]

Q; "Aortic Valve Sclerosis is important to watch as it can progress to **aortic valve stenosis which is a thickening of the valve leaflets** that will cause regurgitation as the valve may not function properly."

>>>Slight correction if I understand the comment.  AV stenosis is different from regurgitation.  Aerotic regurg is backflow of blood into the LV chamber rather being pumped into circulation and that can be caused by leaflets not effectively closing AND/OR annulus (valve opening structure) enlargement. This condition if advanced can cause concentric hypertrophy (heart wall thickens) as the heart works harder to compensate for the reduced cardiac output (>less volume per stroke increase in HR and EF)  For the etiology, this type of ventricle is capable of generating greater forces and higher pressures, while the increased wall thickness maintains normal wall stress. This type of ventricle becomes "stiff"  which can impair filling and lead to diastolic dysfunction.

Aorta stenosis is a narrowing of the annulus often the result of calcium buildup and occurs often with the aging population.  Aorta stenosis increases the resistence the left ventricole pumps against.  This condition can pathologically increase intra chamber left ventricle pressure and this can cause the atrium (left) to enlarge and that can also cause reduced filling.  This also can cause diastolic disfunction.

Q: "Can you tell from looking at the detail values on why the conclusion states that. Is Aortic Valve Sclerosis a subjective reading and could be due to ultra sound variations or artifacts?"

......I'll try to evaluate the degree of abnormal filling pressure,  if any, can be related to tthe E/A ratio.  Normally, early filling exceeds the atrial component of filling (first there is an (E) early flow of blood into the LV and "A", and so the mitral inflow velocity profile shows a bigger E than A wave. With impaired relaxation (wall thickness), the E component will be reduced, resulting in a lower E:A ratio. Conversely, with a restrictive pattern (concentric LV), the E component is said to be increased , resulting in an abnormally high E:A.

Hope this helps provide an insight. I'm guessing that the echo could have picked up an artifact and that based on the rest of the findings, your doctor was assured that all was well. Since it is an "abnormal" finding, for peace of mind, give the office a call and leave a message for the doctor about your concerns.  I'm sure the doctor can put everything into perspective and reassure you about the findings.

Thank you for sharing.  Take care,

Ken

[erijon]

Aortic Valve Sclerosis is important to watch as it can progress to aortic valve stenosis which is a thickening of the valve leaflets that will cause regurgitation as the valve may not function properly. This is the cause of the common murmur you always hear about. This is not a definitive marker for progression of future cardiac events, but your doctor will most likely want to check on it every so often to make sure it's not progressing. As with most readings on a echo, they are subject to interpretation and may vary from one echo to another.

I would not be concerned about this based on what I'm reading in your post. Just ask your doctor how often he plans of checking it.

I think it's safe for you to relax and be happy with your results!

Jon

[Dentalmaniac]

Jon thank you so much for answering my question. I feel a lot better now. However, I'm still concerned about the Aortic Valve Sclerosis diagnosis shown on the stress Echo.  Can you tell from looking at the detail values on why the conclusion states that. Is Aortic Valve Sclerosis a subjective reading and could be due to ultra sound variations or artifacts? I think i'm somewhat of a hypochondriac and whenever i come across any abnormal results i worry too much.

thanks again!

[erijon]

These are pretty much all normal, really nothing disturbing that I can see. The LVH is noted because your septal wall thickness was 1.17 cm and should be at 1.1 cm but your number is fine. Most cardiologists don't get concerned until it exceeds 1.5 cm and yours could be due to excessive exercise resulting in more muscle mass, really nothing to worry about. If these were my results, I would be happy with them.

I'm sure others will post as well, but there's my 2 cents.

Good luck,

Jon