Can you trust an echo to be accurate?

[HopefulHeart]

This question kind of goes with another question I posted on this forum. I just had an echo that measured my aortic aneurysm at 4.8 cm. Since I've always measured at 4.2 cm up till now, an MRI was ordered to verify the measurement. Turns out the MRI showed the aneurysm had not changed, still at 4.2 cm. My Cardio just said the echo "over measured" the aneurysm. Well, 4.8cm vs. 4.2cm is a major "over measure" in my opinion. And if the echo had measured right in the first place, I would not have needed the MRI. Has anyone else had an experience like this with their echos? How can you trust an echo to be accurate after a situation like this?

 

[tom in MO]

I don't know anything about the accuracy of echo measurements except that more than a few people on this board have had their echos verified by another test or even by the same echo cardiogram being interpreted by a different person. The echo is a screening procedure. As a screening procedure it is supposed to have more false positives than false negatives.

 

[VegasBAV]

In my experience, no, you can't trust echos to be accurate. I once had some weird echo results showing some drastically different measurements my cardiologist said the technician probably didn't do a good job.

 

[AZ Don]

FWIW, my aneurysm measurement by echo was 1mm less than the measurement by CT scan. I think that is within the limits of error for even the CT scan. I had both tests done at Mayo Clinic in Phoenix.

 

[ottagal]

tom in MO made a good point. It is a screening tool that is more accurate than not, but is not perfect. That is why another test or another echo is usually done pre-op to verify the findings.
I did have a big change in an echo reading that prompted surgical referral. Although the TEE intra-op showed the 'severity' was not nearly as bad as the echo (TOE) showed, the surgeon did the surgery as I was still considered 'severe' with possible symptoms.

 

[ski girl]

Have you watched what the technician is doing during your echo? They basically freeze an image of your heart, then use the mouse to take measurements of various things. Then those measurements are used to calculate the parameters of interest.

So there's three sources of error - the image of your heart may not be great (i.e. in overweight people, or if they don't catch the heart at the 'correct' place in the beating cycle), their measurement may not be absolutely dead on, and the equation used to calculate something might have constraints.

An example of these constraints - they use an equation to calculate valve area that assumes the valve area is a perfect circle. It's not. So even if they got a brilliant picture of the heart and the technician is incredibly skilful at mouse clicking, the valve area calculated is not going to be what it actually is.

I had an echo in 1998-ish that showed a valve area of 0.7cm2. Several years later I was 1.1cm2. That's impossible! The best we can do is get the same tech and the same machine for each echo, other than that, don't get too hung up on echo results IMHO.

 

[HopefulHeart]

Thanks for all your responses. Your experiences that you shared are very helpful. I suppose I can't expect the echo to be perfect every time. I just feel a little frustrated when an MRI is ordered to verify the echo because the MRI costs me $2000 out of pocket every time. So then I'm stuck paying the sky high fee for the MRI plus the cost of the echo. Since the echo is cheaper, it would be nice for it to be more accurate and reliable. Oh well.

 

[Agian]

they use an equation to calculate valve area that assumes the valve area is a perfect circle. It's not.

Bingo. In my case, one cusp is heavily calcified and useless whereas the other one is almost normal.

 

[ski girl]

Hey Hopefulheart - have you asked them to do a trans-esophageal echo instead? That should be cheaper, worth asking

 

[Rebecca]

I once had a wacko echo. My doctor told me that he thought that it was finally time to have my valve replace. He also sent me to other one of his associate to review my case and after having a repeated echo I was told that it still was not time to replace my valve.

 

[HopefulHeart]

Thanks ski girl...I'll check into that. I had not thought of that as an option. Thanks for the suggestion.

 

[ski girl]

It may not give them the view they want, but it does give a really good view of the aortic valve.

 

[Superman]

My echo in 2009 showed 4.2cm (a 1 cm increase from the prior year echo 3.2cm in 2008 and 2.6cm in 2006). Up to that point, I'd never had a CT scan. A CT scan a couple weeks later showed 4.9cm. Decided to move forward with the replacement due in large part to the dramatic rate of change (big one year jump and possible double in size from three years prior). Even if the echo and CT were off, 1 cm in a year would not have passed the "sleep at night" test for me to wait six months for another CT scan.

But I had no gradual change, and I've had a lifetime of echo's before that to compare as I've been monitored since infancy. It just decided to take off on me.

 

[Bryan B]

An echo is much more susceptible to error by the person doing the test. I have said this in several of your posts but I will say it again. My surgeon, who specializes in aortic root and ascending aorta repair, has told me on numerous occasions that a CT scan is the GOLD STANDARD in measuring aortic aneurysms. A MRI is the 2nd most accurate test with an echo being the least accurate of the 3 tests. He still wants me to get an echo every 18 months to check my tissue valve as the echo is the most accurate of the 3 tests on measurements of the valve.

I wanted to add one more thing about the echo. While the echo did detect dilation of my aortic root, it did not detect my ascending aorta dilation. That was discovered when they sent me to get a MRI to get an accurate measurement of my aortic root.

 

[clay_from_nj]

Probably why I never had an MRI or CT - no sign of aneurysm. Of course, I did wind up having the best check of my aorta that can be done: eyeballing it in person!

 

[HopefulHeart]

An echo is much more susceptible to error by the person doing the test. I have said this in several of your posts but I will say it again. My surgeon, who specializes in aortic root and ascending aorta repair, has told me on numerous occasions that a CT scan is the GOLD STANDARD in measuring aortic aneurysms. A MRI is the 2nd most accurate test with an echo being the least accurate of the 3 tests. He still wants me to get an echo every 18 months to check my tissue valve as the echo is the most accurate of the 3 tests on measurements of the valve.

I wanted to add one more thing about the echo. While the echo did detect dilation of my aortic root, it did not detect my ascending aorta dilation. That was discovered when they sent me to get a MRI to get an accurate measurement of my aortic root.

Thanks Bryan B.....your info is very helpful. I've had 2 CT scans, but my Cardio decided he did not want to do CT scans yearly, or even every 2 or 3 years due to the radiation exposure. Since I'm 39 and would have many more CT scans before I reach old age, he was concerned about cancer from radiation exposure. He said it has happened in a couple of cases with people who had many scans over the course of their lives. Perhaps he's being overly cautious, but I don't mind. I have been told that the CT is very good with accuracy, followed by the MRI....just like you were told. After hearing several people share stories of how they got crazy readings from their echo, I don't know why anyone would pay for an echo. I suppose it's better than no scan at all given that CT and MRI are so expensive and echo is more affordable....but I still wouldn't call the echo cheap. I also don't think that echo techs should be allowed to perform a scan on someone and produce measurements that are way off the mark. That's just not fair to the patient. Especially us heart patients whose heart measurements could mean the difference between surgery or no surgery. Gggrrrr.....sorry, I better stop typing as my blood pressure is starting to go up.

 

[mbeard]

One last comment on skill of echo techs, HopefulHeart

One last comment on skill of echo techs, HopefulHeart

Thanks Bryan B.....your info is very helpful. I've had 2 CT scans, but my Cardio decided he did not want to do CT scans yearly, or even every 2 or 3 years due to the radiation exposure. Since I'm 39 and would have many more CT scans before I reach old age, he was concerned about cancer from radiation exposure. He said it has happened in a couple of cases with people who had many scans over the course of their lives. Perhaps he's being overly cautious, but I don't mind. I have been told that the CT is very good with accuracy, followed by the MRI....just like you were told. After hearing several people share stories of how they got crazy readings from their echo, I don't know why anyone would pay for an echo. I suppose it's better than no scan at all given that CT and MRI are so expensive and echo is more affordable....but I still wouldn't call the echo cheap. I also don't think that echo techs should be allowed to perform a scan on someone and produce measurements that are way off the mark. That's just not fair to the patient. Especially us heart patients whose heart measurements could mean the difference between surgery or no surgery. Gggrrrr.....sorry, I better stop typing as my blood pressure is starting to go up.

I don't want to get your blood pressure up, but one last bad echo tech story. When I got my first echo, last summer, after experiencing what I thought was extreme altitude sickness in Wyoming, a trainee started my echo. She spent 45 minutes on me, then went and got her supervisor. She in turn spent 45 minutes on me, and asked , "have you ever had an echo?". No I said. And began to worry. She left and left the trainee to train on me some more.

The diagnosis was VSD, Ventrical septal defect, basically a hole in my heart. Went home that night and looked at the Internet about and cried and cried. Then 2 cardiologists said that was incorrect, and a TEE was performed and my bicuspid valve and thoracic aneurysm, 4.2 was discovered. A roller coaster of emotions that started with a bad echo diagnosis.

This forum has helped me realize that valve patients may have many experiences like this.

 

[HopefulHeart]

A roller coaster of emotions that started with a bad echo diagnosis.

.

That's exactly what it is. Imagine if you took your car in for service and the service guy came out and said your engine was blown and you have to buy a new car. So you panic about having no car, and then find out afterwards that it was just a small problem with the ignition. You'd never take the car back to that first service center again thinking they could not be trusted and did not know what they were doing. That's how I feel about the echo after my experience.

 

[mbeard]

Echo experience .

Echo experience .

That's exactly what it is. Imagine if you took your car in for service and the service guy came out and said your engine was blown and you have to buy a new car. So you panic about having no car, and then find out afterwards that it was just a small problem with the ignition. You'd never take the car back to that first service center again thinking they could not be trusted and did not know what they were doing. That's how I feel about the echo after my experience.

I feel your pain, my friend. I know I need to "breathe and breathe in.". We will stay in touch .

 

[tom in MO]

mbeard, sounds like the place you get your echos is not practicing good quality control. My echos are done by a technician who tells me nothing. The work is processed and reviewed with a diagnosis given by an doctor that specializes in echocardiograms. This is then passed on and then reviewed by my primary cardiologist. The cardiologist calls you to give the results, next day if bad news, within a week if good. Whatever they tell me has been vetted by at least two doctors and the technicians.