Transthoracic Echocardiography: Reporting

A structured, standardized echocardiography report is what turns a completed study into something a referring clinician can actually act on — and something that remains interpretable years later, or when compared against a study performed at a different lab entirely. This page covers what a comprehensive adult TTE report should contain, drawing on ASE’s 2025 reporting standardization guideline. For the acquisitions a report is built from, see Transthoracic Echocardiography: Acquisition Protocol.

Why Standardization Matters

Reporting standardization exists for reasons beyond tidiness: it supports interoperability between health systems, enables meaningful comparison against a patient’s own prior studies, and increasingly feeds structured data used for research and quality registries. A report that uses idiomatic, lab-specific phrasing instead of standardized terminology is harder to compare, harder to mine for quality data, and more prone to ambiguity — particularly with abbreviations that carry multiple possible meanings depending on context and specialty.

Required Report Fields

A complete report includes several categories of information, each serving a distinct purpose:

Header and Administrative Information

• Facility name, echo lab site address, and contact information
• Protocol performed (comprehensive, limited, or a specific special protocol)
• Timestamps sufficient to evaluate workflow: date/time ordered, performed, and interpreted/distributed
• Identification of any prior exam, if known
• Imaging platform and transducer make and model

Clinical Context

• Indication(s) — listed and appropriate given the clinical history, physical findings (including relevant lab and ECG data), and any prior imaging
• Clinical information — known or suspected disease, related signs and symptoms, and relevant prior interventions or imaging
• Demographic information — age (or date of birth), sex, race/ethnicity, height, weight, and body surface area, adequate to support both clinical quality review and research registry compatibility
• Priority — routine, high priority, urgent, or stat, as appropriate

Physiologic Data at the Time of the Exam

• Cardiac rhythm and rate — baseline rhythm plus any significant paroxysmal disturbance during the study
• Blood pressure — obtained at the bedside, concurrent with the start of the exam, rather than copied forward from the medical record. For physiologic maneuvers or staged stress protocols, blood pressure should be re-recorded at each relevant stage rather than reported once for the whole study.
• Ultrasound enhancing agent (UEA) use — whether used, the agent and dose if so, and any reaction

Measurements and Reporting Precision

The measurements section should follow a few specific conventions consistently, rather than each lab inventing its own:

• Precision has a ceiling — velocity, area, and most linear measurements should not be reported with more than one decimal place. An aortic valve peak velocity of 4.2 m/s is appropriate; 4.21 m/s implies a precision the measurement doesn’t actually have.
• Hemodynamic and volume measurements are whole numbers — calculated pressures, stroke volumes, regurgitant volumes, LVEF, and LA volume are all reported without decimal places.
• Ranges collapse to a single averaged figure — where a value is naturally expressed as a range (an estimated RA pressure of 0–5 mmHg, for instance), the report states the average of that range as a single number rather than the range itself.
• Multiple measurement stages get tagged, not merged — baseline values, post-maneuver values, and each stage of a stress protocol should each be clearly attributable to their specific stage, not collapsed into one ambiguous figure.

The Interpretation Section

The interpretation should provide an anatomical and functional description of each of the four cardiac chambers, the four valves, the pulmonary veins (where relevant), the pericardium, the aorta, the pulmonary artery, and the SVC and IVC, along with any pertinent devices or extracardiac findings. If a structure genuinely cannot be evaluated, the report should say so explicitly rather than simply omitting comment on it — the distinction between “normal” and “not adequately visualized” matters to whoever reads the report next.

Extracardiac findings — pleural effusions (and their laterality), ascites, and other suspected incidental abnormalities within the field of view in the chest, abdomen, or neck — should be documented, with a recommendation for dedicated additional imaging where appropriate.

When measurements for a single lesion disagree — for example, discordant severity grading across different parameters for the same valve lesion — the report should explain the discordance rather than presenting conflicting figures side by side and leaving the reader to reconcile them. Clinical judgment and integration across the full data set, not any single number, should drive the final graded severity.

The Summary Statement

Every echocardiography report should include a summary statement, and “summary statement” is the preferred term by consensus over “concluding statement” or “conclusions” — a small point of standardized terminology worth adopting consistently. The summary statement belongs at the top of the report, immediately following the demographics and indication sections, so it’s the first substantive content a reader encounters.

For a comprehensive TTE report, the summary statement should cover five essential elements:

1. Assessment of left and right ventricular function
2. Presence or absence of significant valvular abnormalities
3. Clinically important positive findings
4. Pertinent negative findings, when applicable
5. A comparison statement, relating the current findings to the most recent prior study where one exists

For TEE reports and limited TTE reports, the summary statement can be more focused — centered on the key positive and pertinent negative findings relevant to the specific indication, rather than all five comprehensive elements. For stress echocardiography reports, the summary statement should state the overall interpretation directly: normal, ischemia, a fixed wall motion abnormality, or a combination, as appropriate to the protocol.

The summary should be written as clear, independently interpretable sentences or bullet points — not simply a restatement of the full body of the report — and any critical finding should be labeled as such and placed where it’s immediately obvious, typically as the first entry.

Limited (Problem-Focused) Study Reporting

A limited study report carries its own specific conventions, distinct from a comprehensive report:

• Comment on everything actually visualized, not only the structures tied to the study’s indication — even a study performed specifically to assess pericardial effusion size should still comment on the chambers and valves that were, in fact, seen, however briefly.
• Reference the most recent comprehensive study, including its date, or state that the study was performed for additional or focused clinical information — this gives the reader the context the focused exam sits within.
• Avoid redundant restatement of prior comprehensive findings, but still report any genuinely new incidental finding.
• The overall structure of a limited report should mirror a comprehensive report’s organization, just scoped down to what was actually acquired — not a fundamentally different report format.

Image Quality Documentation

Every report should include a statement on the overall quality of the echo images, along with an explanation when quality is suboptimal (large body habitus, pulmonary disease, small rib spaces, breast implants, positioning difficulty, or mechanical ventilation are common, specific reasons worth naming rather than a vague “technically difficult study”). Comments on technical image quality and on diagnostic adequacy should be kept separate, since the two don’t always track together — a Doppler measurement can be highly accurate even when overall 2D image quality is suboptimal. Where a specific acoustic window (parasternal, apical, subcostal, or suprasternal) was not present or not interpretable, the report should name it specifically rather than leaving the reader to infer which windows were actually usable.

Personnel and Distribution

A complete report identifies the ordering clinician, the sonographer or physician who performed the study, any trainees involved in performance or interpretation, and the interpreting physician — whose “signature” should carry a date and time stamp. Report distribution, including any critical results, should follow the institution’s policy for timeliness, and reports should be available in both electronic and print-ready formats consistent with the facility’s confidentiality standards.

A Note on Terminology and Abbreviations

Abbreviation use should be limited and consistently defined, and avoided specifically within the indication(s) and summary statement fields, where ambiguity has the most direct clinical consequence. Some abbreviations carry multiple possible meanings depending on context (a well-known example across medicine generally, not unique to echocardiography) — when in doubt, spelling a term out in full costs little and removes any ambiguity entirely.