British Society of Echocardiography

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1 British Society of Echocardiography Affiliated to the British Cardiac Society A Minimum Dataset for a Standard Adult Transthoracic Echocardiogram From the British Society of Echocardiography Education Committee John Chambers, President of the BSE Navroz Masani, Chairman Jane Hancock Jane Graham Gill Wharton Adrian Ionescu 1. Introduction 1. 1 The BSE Education Committee recommendations will be concerned with the key components of a standard adult transthoracic study: indications; echocardiographic views and measurements; the report. 1.2 The intended benefits of these recommendations are to: Support cardiologists and echocardiographers to develop local protocols and quality control programs for adult transthoracic study Promote quality by defining a minimum dataset of descriptive terms and measurements and systematic approach to constructing a report Facilitate the accurate comparison of serial echocardiograms performed in patients at the same or different sites Facilitate the transition to digital echocardiography acquisition and reporting systems that utilise database (software) architecture 1.3. This document gives recommendations for the minimum image and analysis dataset comprising a standard adult transthoracic echocardiogram (Minimum Dataset). This is usually only sufficient when the echocardiographic study is entirely normal. 1.4 There is broad agreement over what views and recordings are essential in any standard study. Views and measurements not supported unanimously are given in italics. 1.5 Focused studies may be appropriate in circumstances agreed locally, for example to rule out a pericardial effusion in a patient on ITU. These should be identified as not being standard echocardiograms and are not covered by these minimum standards. 1.6 When the condition or acoustic windows of the patient prevent the acquisition of one or more components of the Minimum Dataset, or when measurements result in misleading information (e.g. off-axis measurements) this should be stated. 1.7 A scheme for guiding a more comprehensive study in the presence of pathology is given in annex A. Further annexes are being developed.

2 2. Identifying information Patient name A second unique identifier such as hospital number or date of birth Identification of the operator e.g. Initials 3. An ECG should be attached 4. The study 4.1 2D Views Parasternal long axis Parasternal short axis at the following levels a. aortic valve (base) b. mitral leaflet tips c. papillary muscles Apical four chamber Apical five chamber Apical two chamber Apical long axis Subcostal views to show the right ventricle, atrial septum and inferior vena cava Suprasternal view 4.2. M-mode or 2D measurements 4.2.1LV dimensions from the parasternal long axis or short axis view a. Septal thickness at end diastole b. Cavity size at end diastole c. Posterior wall thickness at end diastole d. Cavity size at end systole Aortic root dimension Left atrial dimension 4.3 Colour Doppler mapping For the pulmonary valve in at least one imaging plane For all other valves in at least two imaging planes. 4.4 Quantitative Spectral Doppler Pulsed Doppler at the tip of the mitral leaflets in the apical 4-chamber view. Note E and A velocities, and E deceleration time Pulsed Doppler in the left ventricular outflow tract. Note systolic velocity integral Continuous wave Doppler across the aortic valve in the apical 5-chamber view. Note the peak velocity Continuous wave Doppler across the tricuspid valve if tricuspid regurgitation is seen on colour Doppler. Note peak velocity Pulsed or continuous wave Doppler in the pulmonary artery

3 Annex A: Recommendations for performing a standard adult transthoracic echocardiogram Introduction 1.1 This table is an outline for a comprehensive transthoracic study, which includes the Minimum Dataset with the inclusion of additional views and measurements (Additional Data). 1.2 The table summarises the minimum and additional data comprising the standard adult transthoracic study by: 1. View (first column) 2. Modality within each view (second column) 3. Structure assessed in each view, by modality (third column) 4. Measurements made in each view, by modality (fourth column) 5. Derived calculations (fifth column) 1.3 Views, modalities, measurements and calculations additional to those in the minimum dataset (Additional Data) are annotated [A] 1.4 Well accepted and commonly used abbreviations are used: CFM DET LVDd/s LVSd/s LVPWd/s PHT RVd colour flow mapping desceleration time left ventricular diameter in diastole and systole left ventricular septal width in diastole and systol left ventricular posterior wall width in diastole and systole pressure half-time right ventricular cavity diameter in diastole

4 PLAX 2D LV cavity size, wall thickness, function LVIDd/s, LVSd/s, LVPWd/s FS [A] LA size Las Aortic root, AV appearance and function annulus 1, root 2, ridge 3 asc. 4 [] MV appearance and function MV annulus [] M mode [A] LV cavity size, wall thickness LVIDd/s, LVSd/s, LVPWd/s FS RV cavity size (RVd) MV ± ES separation AV/aortic root/la size Las, cusp separation, root LA:Ao [A] CFM MV inflow / LVOT / AR AR width [ AR:LVOT [A] (VSD) RV inflow 2D [A] RA, IVC, SVC, ± coronary sinus CFM TV inflow, TR CW TR Vmax PAs pressure RV outflow 2D RVOT, PV, main PA PV annulus [A] CFM RVOT, PS, PR, PA PW RVOT Vmax, Vmean, VTI CW PS Vmax, Vmean Pmax, Pmean PR Vmax PRed PAd pressure

5 PSAX 2D LA, atrial septum (base) RA PV, PA s PV annulus [A] AV appearance and function CFM SVC, RUPV, atrial septum [A] TV inflow, TR [A] RVOT, PS, PR, PA (PDA) [A] PW RVOT [A] Vmax, Vmean, VTI CW TR [A] Vmax PAs pressure PS [A] Vmax, Vmean Pmax, Pmean PR [A] Vmax Pred PAd pressure PSAX (MV) 2D LV size, wall thickness, function [basal seg s] MV appearance and function MVA planimetry [A] CFM MV inflow, [A] (VSD) PSAX (cords) 2D LV size, wall thickness, function [mid seg s] CFM (VSD) PSAX (apex) 2D LV size, wall thickness, function [apical seg] CFM (VSD) A4C 2D LV cavity size, wall thickness, function [IS, lat] LA size Area or volume [A] LA vol index[a] RA size Area or volume [A] RA vol index[a] MV appearance and function CFM TV inflow, TR MV inflow, PW LV inflow (MV tips) E, DET, A EAR IVRT [A] CW MS Vmax, Vmean [A] Pmax, Pmean PHT [A] MVA TS Vmax, Vmean [A] Pmax, Pmean TR Vmax PAs pressure

6 A4C 2D LV cavity size, wall thickness, function [IS, lat] LA size Area or volume [A] LA vol index[a] RA size Area or volume [A] RA vol index[a] MV appearance and function CFM TV inflow, TR MV inflow, PW LV inflow (MV tips) E, DET, A EAR IVRT [A] CW MS Vmax, Vmean [A] Pmax, Pmean PHT [A] MVA TS Vmax, Vmean [A] Pmax, Pmean TR Vmax PAs pressure A5C 2D LV cavity size, wall thickness, function [AS] LVOT, AV appearance and function CFM LVOT, AV PW LVOT TVI [A] SV, CO Vmax, Vmean [A] Pmax, Pmean CW LVOT, AS Vmax, Vmean [A] Pmax, Pmean AR DET [A] A2C 2D LV cavity size, wall thickness, function [ant, inf] MV appearance and function CFM LV inflow, [A] PW [O] LV inflow (MV tips) E, DET, A (IVRT [A]) EAR CW [O] MS Vmax, Vmean Pmax, Pmean

7 ApLAX 2D LV cavity size, wall thickness, function LVOT, AV appearance and function CFM LV inflow, LVOT, AV PW [O] LV inflow (MV tips) E, DET, A (IVRT [A]) EAR LVOT TVI SV, CO Vmax, Vmean Pmax, Pmean CW [O] MS Vmax, Vmean Pmax, Pmean LVOT, AS Vmax, Vmean Pmax, Pmean AR DET Subcostal 4C 2D 4 chamber structures CFM Atrial septum 4 chamber structures Subcostal SAX 2D SAX structures Atrial septum IVC, Hep. V (modified view) Desc. Aorta (modified view) M mode IVC Respiratory variation CFM SAX structures Atrial septum IVC, Hep. V Desc. Aorta PW Hep. V Desc. Aorta Suprasternal 2D Arch CFM Arch, coarctation, PDA PW Desc. Aorta Flow reversal [A] CW Asc. Aorta (AS) Vmax, Vmean [A] Pmax, Pmean Desc. Aorta (coarct) Vmax, Vmean [A] Pmax, Pmean