Table 2.
Cardio-Oncology Targeted Echocardiogram Reporting Protocol
| View (Modality) | Measurement | Explanatory Note | Image |
|---|---|---|---|
| Vital signs | Blood pressure, heart rate and rhythm | ||
| A4C and A2C 2D | Simpson’s biplane volumes and LVEF | Trace the endocardial border. Depending on the vendor, the MV level contour is made by a straight line at the beginning or end of tracing. LV length is defined as the distance between the midpoint of the MV-level line and the most distal point of the LV apex. Take care to ensure the LV is not foreshortened. Papillary muscles and trabeculations are included in the volumes and considered part of the chamber. Measure at end-diastole and end-systole. Volumes indexed to BSA. |
 |
| Apical 3D | 3D volumes and LVEF | See Table 1 | |
| A4C/A3C/A2C | GLS | See Table 1 | |
| A4C LV TDI | S′ | Place sample volume (5 to 10 mm) at or within 1 cm of the insertion of the MV leaflets. Angle of interrogation should be as parallel to Doppler beam as possible. Measure at end-expiration. Optimize scale and sweep speed (100 mm/s). Average both septum and lateral wall measurement. S′: Peak systolic velocity. |
 |
| Modified A4C RV (2D) | RVD1 (± RVD2/RVD3) | RVD1: Basal RV diameter. Measured at the maximal transverse diameter in the basal one-third of the RV. RVD2: Mid-RV diameter measured at the level of the LV papillary muscles. RVD3: RV length, from the plane of the tricuspid annulus to the RV apex. |
 |
| CWD TV | TR peak velocity (TRVmax) | Peak TR velocity is measured by CWD across the tricuspid valve. Ensure the CWD to flow angle is correctly aligned. Eccentric jets can lead to incomplete Doppler envelopes and underestimation of TR velocity. A high sweep speed (100 mm/s) can help to differentiate between true velocities and artifact. Measure from a complete TR envelope. Choose the highest velocity. Accuracy is greatest when ultrasound and blood flow are parallel. |  |
| A4C RV (TDI) | RV S′ | PW tissue Doppler S′ wave measurement taken at the lateral tricuspid annulus in systole. It is important to ensure the basal RV free wall segment and the lateral tricuspid annulus are aligned with the Doppler cursor to avoid velocity underestimation. A disadvantage of this measure is that it assumes that the function of a single segment represents the function of the entire ventricle, which is not likely in conditions that include regionality such as RV infarction. Normal value ≥9 cm/s (27). |
 |
| A4C Lateral TV annulus (MM) | TAPSE | This is an angle-dependent measurement, and therefore, it is important to align the M-Mode cursor along the direction of the lateral tricuspid or mitral annulus. Select a fast sweep speed. Measure total excursion of the tricuspid annulus. Normal value ≥17 mm (60). |
 |
2D = 2 dimensional; BSA = body surface area; CWD = continuous-wave Doppler; LA = left atrium; LV = left ventricle; MM = M-mode; MV = mitral valve; PW = pulsed wave; RV = right ventricle; RVD = right ventricular diameter; TAPSE = tricuspid annular plane systolic excursion; TDI = tissue Doppler imaging; TR = tricuspid regurgitation; TV = tricuspid valve; other abbreviations as in Table 1.