An echocardiogram report is a structured document that describes your heart’s size, how well it pumps, and whether your valves are working properly. It can look intimidating, with abbreviations like LVEF, E/A ratio, and RVSP scattered across the page. But once you understand the main sections and what the key numbers mean, you can follow along with your results and have a more informed conversation with your doctor.
What an Echo Report Covers
Most echocardiogram reports follow a predictable layout. At the top you’ll find the date, the reason the test was ordered, and a note about image quality (since body size, lung disease, and positioning can all affect how clearly the ultrasound captures your heart). From there, the report moves through a checklist of structures and functions:
- Rate and rhythm: your heart rate during the test and whether the rhythm was regular
- Chamber sizes: measurements of all four chambers
- Left ventricular systolic function: how strongly the main pumping chamber contracts
- Left ventricular diastolic function: how well that chamber relaxes and fills
- Right ventricle: size and pumping ability of the right side
- Valve function: whether any valves leak (regurgitation) or are too narrow (stenosis)
- Wall motion: whether every segment of the heart muscle moves normally
- Pericardium: the sac surrounding the heart, checked for fluid buildup
- Aorta: the size of the first portion of the body’s largest artery
At the bottom you’ll find a summary pulling together the most important findings. This is often the most readable part, but understanding the sections above it gives you the full picture.
Ejection Fraction: The Headline Number
The single most referenced number on an echo report is the left ventricular ejection fraction, abbreviated LVEF or simply EF. It tells you what percentage of blood in the left ventricle gets pumped out with each heartbeat. A normal EF falls between about 50% and 70%. If your report says “LVEF 60%,” your heart is squeezing with normal strength.
An EF between 41% and 49% is considered mildly reduced. At 40% or below, it’s classified as reduced and is the hallmark of heart failure with reduced ejection fraction. This doesn’t mean your heart has stopped working, but it does mean each beat is moving less blood than it should, and your doctor will likely want to discuss treatment options.
Keep in mind that EF is an estimate. Different measurement methods (visual estimate, biplane tracing, 3D imaging) can give slightly different numbers, so a shift of a few percentage points between two tests isn’t necessarily meaningful. What matters more is whether the value consistently falls into a normal or reduced category.
Chamber Sizes and What “Dilated” Means
Your report will list measurements for each heart chamber in millimeters. For the left ventricle, the main pumping chamber, a normal internal diameter during relaxation (diastole) is roughly 42 to 58 mm in men and 38 to 52 mm in women. When relaxed, the right ventricle is normally 25 to 41 mm across at its widest point. The left atrium, measured front to back, is typically 30 to 40 mm in men and 27 to 38 mm in women.
If a chamber measures larger than normal, the report will describe it as “dilated.” A dilated left atrium, for instance, is one of the most common findings and is often linked to high blood pressure or valve problems. A dilated left ventricle can signal that the heart has been working harder than it should for an extended period. The word “dilated” on its own isn’t a diagnosis. It’s a clue that points toward a cause your doctor will investigate further.
You may also see the term “hypertrophy,” which means the heart muscle wall is thicker than normal. This is different from dilation. A thick wall usually develops in response to chronic high blood pressure, forcing the muscle to bulk up the same way a bicep thickens with repeated lifting.
Wall Motion: How Each Segment Moves
The echo technician and reading physician evaluate how every segment of the left ventricle contracts. Normal wall motion means all segments thicken and move inward evenly during each beat. When a segment isn’t moving well, the report uses specific terms to describe the severity:
- Hypokinesis: the segment moves, but less than it should
- Akinesis: the segment doesn’t move at all
- Dyskinesis: the segment bulges outward when the rest of the heart squeezes inward
- Aneurysmal: a segment is permanently thinned and bulging
These findings matter because they often point to coronary artery disease. If a segment of heart muscle isn’t getting enough blood flow, or if it was damaged by a previous heart attack, it won’t contract normally. The location of the abnormality can even suggest which coronary artery is involved, which is why your cardiologist pays close attention to exactly where the problem appears.
Valve Function: Regurgitation and Stenosis
Your heart has four valves, and the echo report grades how well each one opens and closes. There are two main problems a valve can have. Regurgitation means the valve leaks, allowing blood to flow backward. Stenosis means the valve is too stiff or narrow, restricting forward flow.
Both are graded on a scale. Regurgitation is rated as trace or trivial (barely detectable), mild (1+), moderate (2+), moderate-to-severe (3+), or severe (4+). Trace or mild regurgitation of certain valves, particularly the tricuspid valve, is extremely common and usually harmless. Many perfectly healthy hearts show a tiny amount of leakage. Moderate or severe regurgitation is a different story, as it can overwork the heart over time and may eventually require intervention.
Stenosis is also graded as mild, moderate, or severe, based on how fast blood accelerates as it squeezes through the narrowed opening. Higher velocity and higher pressure gradients mean a tighter valve. Severe aortic stenosis, for example, is one of the most common valve problems that leads to valve replacement.
The report often uses color Doppler imaging to assess valves. Different colors on the ultrasound image represent blood flowing in different directions, making it easier to spot and measure leaks.
Diastolic Function: How Well Your Heart Relaxes
This section confuses more people than any other part of the report, partly because it involves several measurements that interact with each other. Systolic function (the EF) measures how well the heart squeezes. Diastolic function measures how well it relaxes and fills between beats. You can have a perfectly normal EF and still have diastolic dysfunction, which is the basis of a condition called heart failure with preserved ejection fraction.
The key measurement here is the E/A ratio. “E” represents the speed of blood rushing into the ventricle during early relaxation, while “A” represents the speed during the final push from the atrium’s contraction. In a young, healthy heart, the E wave is taller than the A wave, giving a ratio above 1. As the heart stiffens with age or disease, the pattern shifts.
Diastolic dysfunction is graded from 1 to 3. Grade 1 is the mildest form, where the heart relaxes more slowly than normal. The E/A ratio is typically 0.8 or lower, and filling pressures remain normal. Many people over 60 have grade 1 diastolic dysfunction without any symptoms. Grade 2 means filling pressures in the heart are starting to rise, with an E/A ratio between 0.8 and 2. Grade 3 is the most severe, with an E/A ratio of 2 or higher, indicating significantly elevated pressures. The higher the grade, the more the heart struggles to fill properly, which can cause shortness of breath, especially with exertion or when lying flat.
Right Heart and Pulmonary Pressure
The right side of the heart pumps blood to the lungs, and the echo report estimates the pressure in that circuit using a measurement called right ventricular systolic pressure (RVSP). Normal RVSP is below 40 mm Hg. Values between 40 and 49 are mildly elevated, 50 to 59 is moderate, and 60 or above is severely elevated. Elevated RVSP suggests pulmonary hypertension, meaning the blood vessels in the lungs are under higher pressure than they should be. This can result from left-sided heart disease, lung conditions, blood clots in the lungs, or other causes.
The report may also note the right ventricle’s pumping function. One common measure is TAPSE, which tracks how much the base of the right ventricle moves toward the apex during contraction. Lower values suggest the right ventricle isn’t squeezing effectively.
Findings That Raise Concern
Not every abnormality on an echo is urgent. Trace valve leaks, mild diastolic dysfunction, and borderline chamber sizes are common and often require only monitoring. But certain findings demand prompt attention. A large pericardial effusion (fluid around the heart) with signs of tamponade, meaning the fluid is compressing the heart and impairing its ability to fill, is an emergency. Severe valve regurgitation, particularly if it’s new, can indicate a sudden structural problem like a torn valve. A vegetation, which is an abnormal growth on a valve larger than about 1 cm, raises concern for an active heart infection called endocarditis.
A significantly reduced EF, new wall motion abnormalities suggesting a heart attack, or severely elevated pulmonary pressures are also findings that typically trigger further testing or treatment changes. If your report contains any of these, your doctor’s office will usually reach out rather than waiting for a routine follow-up.
Putting It All Together
When you read your echo report, start with the summary at the bottom for the big picture, then work backward into the specific sections for detail. Focus first on the ejection fraction, then check whether your chamber sizes and valve function are described as normal. Look at the diastolic function grade if one is listed, and note any wall motion abnormalities.
Echo reports describe your heart at a single point in time. Trends matter more than any individual number, which is why cardiologists often compare your current echo to previous ones. A stable, mildly reduced EF over several years tells a very different story than one that dropped from 55% to 35% in six months. Keeping copies of your reports makes it easier to track those trends yourself and ask informed questions at your next appointment.