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One size fits all....

Aug 02, 2011 - 0 comments

while researching I found some info on the CHF patients' website that's disturbing and makes me question echo guidelines and standards; even my dr's are stumped when I ask them what are the echo parameter standards?

"Even though the labs routinely used the terms "mild," "moderate," and "severe", they admitted that they had no standard guidelines as to what exactly these words meant.  This means that interpreting echo results is partly subjective.  Sources of variability include the patient, the echo tech, the techniques used to obtain the images, the methods used to analyze the images, the equipment, and the reader."   (http://www.chfpatients.com/tests/echo.htm)

"Despite the widespread use of echo, interpreting echo measurements is seriously limited by lack of standards. There is no agreement among operators about adjusting reference values by sex or age; the proper way to adjust for body size; or the precise definitions of terms like "mild" and "severe." These are urgent matters that must be resolved to make echo results more consistent."

"When developing cut-points that separate "illness" from "health," testers must decide which measurements to use, because echo dimensions vary according to sex, age, and race. Most reference values we found were not partitioned at all. It was one size fits all, which simply cannot be accurate."

"The impact of sex on heart size and measurements is well known. Autopsy data, x-ray studies, and MUGA studies show smaller heart size in women compared to men. Studies show larger heart size in men even after accounting for differences in body size. In other words, men's hearts are usually bigger in relation to their body size than women's hearts."

This is in reference to this thread: http://www.medhelp.org/posts/Heart-Disease/When-is-a-ventricle-to-thick-/show/1388676 where I was questioning about echo parameters and why there are differences in the measurements sometimes, so I googled echocardiagram parameters and came up with a bunch of conflicting normal variants.

I asked about this -  "Left Ventricular Internal Dimension (systole); normal range 21 - 40 mm.  The report is an estimate of LV dimension and the given size is 40 mm and certainly within the margin of error"

"For clarification: The normal values for LV systolic 30 to 40mm.  LV diastolic is 52 to 70 mm.  The septum wall (separates the left side from right side (11-13 mm). With HCM the septum is often is enlarged as well."

The link I was given is this: http://www.researchgate.net/group/internal_medicine_clinical_pharmacology/board/thread/14141_echocardiography-refvalues_updates_2009

LV diastolic diameter 35-57mm
LV systolic diameter 24-35mm
LVSeptum diastolic diameter 7-12mm

a dr on all experts says this is a good site - http://www.echobyweb.com/htm_level2_eng/normal_parameters_tt.htm

End-diastolic diameter 49±4 mm  
End-sys tolic diameter 30±5 mm
Interventricular septum thickness 9±1 mm

here's one for CHF patients... http://www.chfpatients.com/tests/echo.htm
left atrium 36 to 47 mm
aortic root 33 to 44 mm
left ventricular end-diastolic diameter 52 to 70 mm
left ventricular end-systolic diameter 30 to 40 mm
left ventricular wall thickness 11 to 13 mm

one for healthy hearts - http://www.chfpatients.com/tests/echo.htm
left atrium 35 to 41 mm
aortic root 32 to 39 mm
left ventricular end-diastolic diameter 53 to 58 mm
left ventricular end-systolic diameter 30 to 40 mm

The link was great for some things I didn't have parameters to such as:
Systolic 15–25 mm Hg
Diastolic 8–15 mm Hg
Mean 10–20 mm Hg
PCWP (PAOP) 6–12 mm Hg
Cardiac output 3.5–5.5 L/min
Cardiac index 2.8–3.2 L/min/m2

what is the "standard" for echo parameters and who sets these standards?

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