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Variations in LV M-Mode measurements
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Variations in LV M-Mode measurements

About me: 31 y/o male, 6', 160 lbs, relatively sedentary with brief periods (a few months at a time, a few times a year) of regular exercise, blood pressure usually in mid-to-high 120s/mid-to-high 70s.

Four years ago I saw a cardiologist for palpitations & chest pain.  It was ultimately determined to be anxiety related after a normal stress test including EKG/Echo.  One year ago I had another echo done at the request of my gastroenterologist due to pain I was experiencing.  I guess he wanted to rule out cardiac causes even though he had just diagnosed me with a hiatal hernia.  

I recently acquired copies of the reports from both the echos.  In the first echo, my LVPWd was 0.7 cm and IVSd was 0.8 cm, both at the low end of normal.  Three years later, my LVPWd was 1.1 cm and IVSd was 1.2 cm, one at the upper limit of normal, the other above.  The notes on the second suggested borderline LVH and possible diastolic dysfunction.  After speaking to my cardiologist, he suggested that the different machines/technicians/interpreters could result in the differences in measurements and that he was not worried about it.  He said he would only trust changes in consecutive echos when performed by his tech on his machines interpreted by his guy.  Then he said what frustrated me, which was that with my readings my insurance would not pay for another echo until 2 years after my most recent one.  He scheduled an echo "just to check it out" in October, which will be 2 years after my last one.  

I worry now that perhaps there could be an issue but that since insurance won't pay for another echo now, he's going to put it off at the expense of my health.  Have any of you had readings that differed like this in which your cardiologist is not concerned? Have you noticed differences in M-Mode measurements on echos from different locations?  Any insight or experiences are appreciated  Thanks.
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I should add that the echos were done at different facilities and interpreted by different MDs.
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Avatar_m_tn
It is generally accepted that echos my have about a 5% of "operator errors".

And your figures are very close to that. So most probably your Dr. is right. In the other hand any serious cardiac issue  would had produced much bigger differences over 3 years time.

Jesus

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367994_tn?1304957193
Echo measurements are estimates.  I watched my tech during an echo and the hand held transducer attempts to outline a fuzzy border border ionduced by heart wall movement.  Faster beating hearts can be more difficult to define an accurate border.  Your metric is a sight variation  within an acceptable margin of error.

Q: The notes on the second suggested borderline LVH and possible diastolic dysfunction.

>>>>the borderline LVH is considering thickened heart walls and accepting the septal wall dimension and the posterior wall dimension has possible DD.  DD would be due to thickened heart walls do not relax and are rigid enough to impair vetricular filling and the comment is computer generated.  .

It seems the echo software does the calculations based on the parameters of the transdurer input. The tech is responsible for estimating and sizing with a transducer, and the doctor considers correlating the test output, other tests, symptoms, etc. to evaluate your cardic health. It is not unreasonable for your doctor to suggest waiting for the results of another test.  Worst case scenario doesn't put you at any health risk if the doctor hasn't correlated your health history, other tests, your symptoms, etc.  You shouldn't be concerned.

Thanks for sharing, and if you have any further questions or comments you are welcome to respond.  Take care.
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