An echocardiogram report contains dozens of measurements, abbreviations, and grading terms that can look overwhelming at first glance. The key sections to focus on are ejection fraction (how well your heart pumps), chamber sizes, valve function, wall motion, and estimated pressures. Once you know what each section describes and what the normal ranges are, the report becomes much easier to interpret.
Ejection Fraction: The Most Important Number
Ejection fraction (EF) is the percentage of blood your left ventricle pumps out with each beat. It’s the single number most people look for first, and it’s the one your doctor will reference most often.
A normal EF falls between 55% and 70%. An EF from 41% to 49% is considered mildly reduced, meaning the heart isn’t squeezing quite as strongly as it should. An EF under 40% typically indicates heart failure or a condition called cardiomyopathy, where the heart muscle itself is weakened. Some reports also list an EF above 70%, which can occasionally signal a different type of heart problem where the muscle is too thick and the chamber too small.
Your report may show EF calculated two ways: by visual estimate (the sonographer’s judgment) and by a tracing method called the Simpson biplane method. Small differences between the two are normal. What matters is the ballpark, not the exact digit.
Chamber Sizes and What They Mean
Your report will list measurements for all four chambers of the heart, but the left ventricle gets the most attention. The key measurement here is the left ventricular internal diameter in diastole (LVIDd), which is the width of the chamber when it’s relaxed and filling with blood. Normal values are 42 to 59 mm for men and 39 to 53 mm for women. A number above that range suggests the chamber is dilated, which can happen with long-standing high blood pressure, valve leaks, or heart failure.
You’ll also see a measurement for left atrial size, often reported as a volume indexed to your body surface area (LAVI). The normal value is around 20 mL/m², give or take 6. An enlarged left atrium is a red flag for conditions like atrial fibrillation, valve disease, or chronically elevated filling pressures. Think of it as a marker of how hard the heart has been working over time, not just at the moment of the test.
If the report mentions LVH (left ventricular hypertrophy), it means the walls of the left ventricle are thicker than normal. This is common in people with uncontrolled high blood pressure and means the muscle has been working harder than it should for an extended period.
How Valve Function Is Graded
The heart has four valves, and your report will comment on each one. The two main problems a valve can have are stenosis (the valve doesn’t open wide enough, restricting flow) and regurgitation (the valve doesn’t close completely, allowing blood to leak backward). You’ll see these graded as trace, mild, moderate, or severe.
Trace or mild regurgitation in the mitral and tricuspid valves is extremely common and almost always harmless. Many otherwise healthy people have it. Moderate or severe regurgitation is more significant and usually requires monitoring or treatment. For regurgitation, the report may describe the size of the leaking jet, how far back into the chamber the leak extends, and a measurement called the vena contracta, which is the width of the leak at its narrowest point.
Stenosis is most commonly seen in the aortic valve. Mild aortic stenosis means blood is moving through the valve a bit faster than normal because the opening is somewhat narrowed. Severe aortic stenosis, where the valve opening shrinks to 1.0 cm² or less, is a serious finding that often requires valve replacement. The report uses peak velocity (how fast blood shoots through the valve) and mean gradient (the pressure difference across the valve) to determine severity. A peak velocity of 4 meters per second or higher, or a mean gradient of 40 mmHg or higher, indicates severe narrowing.
Understanding Doppler Color Flow
If you’ve seen the colorful images from your echo, those come from Doppler imaging, which tracks the speed and direction of blood flow. The color coding follows a simple rule: red means blood is flowing toward the ultrasound probe, and blue means it’s flowing away. A helpful mnemonic is BART (Blue Away, Red Towards).
When you see a splash of color where it shouldn’t be, like a jet of blue shooting backward through a closed valve, that’s regurgitation. The bigger and brighter that jet, the more significant the leak. Green or mosaic (mixed) colors in the image indicate turbulent flow, which happens when blood is being forced through a narrow or abnormal opening. This turbulence is what makes stenosis and significant leaks visible on the screen.
Wall Motion: Spotting Signs of Damage
The report will describe how each segment of the heart wall moves during contraction. Normal wall motion means every part of the muscle thickens and moves inward evenly when the heart squeezes. Abnormalities in specific segments often point to reduced blood supply from coronary artery disease or damage from a prior heart attack.
There are three levels of abnormal wall motion. Hypokinesis means a segment moves, but weakly. Akinesis means a segment fails to contract at all. Dyskinesis is the most severe: the segment actually bulges outward when the rest of the heart is squeezing inward. The location of the abnormality tells your doctor which coronary artery may be involved, because each artery supplies a predictable territory of heart muscle.
If your report says “no regional wall motion abnormalities,” that’s good news. It means the heart muscle appears to be contracting uniformly throughout.
Estimated Pulmonary Pressures
Your report may include a number labeled PASP (pulmonary artery systolic pressure) or RVSP (right ventricular systolic pressure). These estimate the blood pressure in your lungs’ arteries, and in most cases PASP and RVSP are treated as equivalent. The echo calculates this by measuring how fast a tiny jet of tricuspid regurgitation travels backward and plugging it into a formula.
Among healthy adults, the average PASP is about 28 mmHg, and the upper limit of normal is roughly 37 mmHg. Values above 40 mmHg raise concern for pulmonary hypertension, though the threshold shifts somewhat with age and body weight. Older and heavier individuals can have a PASP near 40 without it being abnormal for them. If the report says there wasn’t enough tricuspid regurgitation to measure, that’s actually a normal finding, and it simply means this number couldn’t be estimated.
Common Abbreviations on the Report
Echo reports are dense with shorthand. Here are the terms you’re most likely to encounter:
- EF: Ejection fraction, the percentage of blood pumped out per beat
- LVIDd: Left ventricular internal diameter in diastole (chamber width at rest)
- LAVI: Left atrial volume index, atrial size adjusted for body size
- LVH: Left ventricular hypertrophy, thickened heart muscle walls
- MR: Mitral regurgitation, leaking of the mitral valve
- AR: Aortic regurgitation, leaking of the aortic valve
- TR: Tricuspid regurgitation, leaking of the tricuspid valve
- AS: Aortic stenosis, narrowing of the aortic valve
- PASP/RVSP: Estimated blood pressure in the lung arteries
- RWMA: Regional wall motion abnormality
Putting the Report Together
No single number on an echocardiogram tells the whole story. A mildly reduced EF with normal chamber sizes and no wall motion abnormalities paints a very different picture than the same EF with a dilated left ventricle, moderate mitral regurgitation, and elevated pulmonary pressures. The report is meant to be read as a whole, with each measurement providing context for the others.
When you review your results, start with the summary or impression section at the bottom. This is where the interpreting cardiologist pulls everything together into plain language findings, ranked by clinical importance. The detailed measurements above it are the supporting evidence. If a number looks abnormal but the summary doesn’t flag it, it may be a borderline value or a normal variant for your age and size.