Normal Values: Difference between revisions
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Below an up-to-date list of echocardiographic normal values. | |||
=Left Ventricle= | |||
==Left Ventricular Systolic Function== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Reference limits and values and partition values of left ventricular function<cite>ASE</cite>''' | |||
|- | |||
! rowspan="2" style="width:200px" | | |||
! colspan="4" | Women !! colspan="4" | Men | |||
|- | |||
! style="width:80px" | Reference range | |||
! style="width:80px" | Mildly abnormal | |||
! style="width:80px" | Moderately abnormal | |||
! style="width:80px" | Severely abnormal | |||
! style="width:80px" | Reference range | |||
! style="width:80px" | Mildly abnormal | |||
! style="width:80px" | Moderately abnormal | |||
! style="width:80px" | Severely abnormal | |||
|- | |||
| colspan="9" | '''Linear method''' | |||
|- | |||
| style="padding-left:12px" | Endocardial fractional shortening, % | |||
| align="center" | 27–45 | |||
| align="center" | 22–26 | |||
| align="center" | 17–21 | |||
| align="center" | ≤16 | |||
| align="center" | 25–43 | |||
| align="center" | 20–24 | |||
| align="center" | 15–19 | |||
| align="center" | ≤14 | |||
|- | |||
| style="padding-left:12px" | Midwall fractional shortening, % | |||
| align="center" | 15–23 | |||
| align="center" | 13–14 | |||
| align="center" | 11–12 | |||
| align="center" | ≤10 | |||
| align="center" | 14–22 | |||
| align="center" | 12–13 | |||
| align="center" | 10–11 | |||
| align="center" | ≤10 | |||
|- | |||
| colspan="9" | '''2D Method''' | |||
|- | |||
| style="padding-left:12px" |<font color="green">''' Ejection fraction, %'''</font> | |||
| align="center" |<font color="green">''' ≥55'''</font> | |||
| align="center" | <font color="green">'''45–54'''</font> | |||
| align="center" |<font color="green">''' 30–44'''</font> | |||
| align="center" |<font color="green">''' <30'''</font> | |||
| align="center" | <font color="green">'''≥55'''</font> | |||
| align="center" |<font color="green">''' 45–54'''</font> | |||
| align="center" | <font color="green">'''30–44'''</font> | |||
| align="center" | <font color="green">'''<30'''</font> | |||
|- | |||
| colspan="9" | <ul> | |||
<li>2D, Two-dimensional.</li> | |||
<li><font color="green">'''Green values'''</font>: Recommended and best validated.</li> | |||
</ul> | |||
|} | |||
==Left Ventricular Diastolic Function== | |||
[[File:diastolicfunction.svg|500px|thumb|left|Practical approach to LV diastolic function grading. Ater <cite>ASEDF</cite>]] | |||
{{clr}} | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Normal values for Doppler-derived diastolic measurements<cite>ASEDF</cite>''' | |||
|- | |||
! style="border-bottom:hidden" | | |||
! colspan="4" | Age group (y) | |||
|- | |||
! style="width:120px" | Measurement | |||
! 16-20 | |||
! 21-40 | |||
! 41-60 | |||
! >60 | |||
|- | |||
| IVRT (ms) | |||
| align="center" | 50 ± 9 (32-68) | |||
| align="center" | 67 ± 8 (51-83) | |||
| align="center" | 74 ± 7 (60-88) | |||
| align="center" | 87 ± 7 (73-101) | |||
|- | |||
| E/A ratio | |||
| align="center" | 1.88 ± 0.45 (0.98-2.78) | |||
| align="center" | 1.53 ± 0.40 (0.73-2.33) | |||
| align="center" | 1.28 ± 0.25 (0.78-1.78) | |||
| align="center" | 0.96 ± 0.18 (0.6-1.32) | |||
|- | |||
| DT (ms) | |||
| align="center" | 142 ± 19 (104-180) | |||
| align="center" | 166 ± 14 (138-194) | |||
| align="center" | 181 ± 19 (143-219) | |||
| align="center" | 200 ± 29 (142-258) | |||
|- | |||
| A duration (ms) | |||
| align="center" | 113 ± 17 (79-147) | |||
| align="center" | 127 ± 13 (101-153) | |||
| align="center" | 133 ± 13 (107-159) | |||
| align="center" | 138 ± 19 (100-176) | |||
|- | |||
| PV S/D ratio | |||
| align="center" | 0.82 ± 0.18 (0.46-1.18) | |||
| align="center" | 0.98 ± 0.32 (0.34-1.62) | |||
| align="center" | 1.21 ± 0.2 (0.81-1.61) | |||
| align="center" | 1.39 ± 0.47 (0.45-2.33) | |||
|- | |||
| PV Ar (cm/s) | |||
| align="center" | 16 ± 10 (1-36) | |||
| align="center" | 21 ± 8 (5-37) | |||
| align="center" | 23 ± 3 (17-29) | |||
| align="center" | 25 ± 9 (11-39) | |||
|- | |||
| PV Ar duration (ms) | |||
| align="center" | 66 ± 39 (1-144) | |||
| align="center" | 96 ± 33 (30-162) | |||
| align="center" | 112 ± 15 (82-142) | |||
| align="center" | 113 ± 30 (53-173) | |||
|- | |||
| Septal e´ (cm/s) | |||
| align="center" | 14.9 ± 2.4 (10.1-19.7) | |||
| align="center" | 15.5 ± 2.7 (10.1-20.9) | |||
| align="center" | 12.2 ± 2.3 (7.6-16.8) | |||
| align="center" | 10.4 ± 2.1 (6.2-14.6) | |||
|- | |||
| Septal e´/a´ ratio | |||
| align="center" | 2.4<sup>∗</sup> | |||
| align="center" | 1.6 ± 0.5 (0.6-2.6) | |||
| align="center" | 1.1 ± 0.3 (0.5-1.7) | |||
| align="center" | 0.85 ± 0.2 (0.45-1.25) | |||
|- | |||
| Lateral e´ (cm/s) | |||
| align="center" | 20.6 ± 3.8 (13-28.2) | |||
| align="center" | 19.8 ± 2.9 (14-25.6) | |||
| align="center" | 16.1 ± 2.3 (11.5-20.7) | |||
| align="center" | 12.9 ± 3.5 (5.9-19.9) | |||
|- | |||
| Lateral e´/a´ ratio | |||
| align="center" | 3.1<sup>∗</sup> | |||
| align="center" | 1.9 ± 0.6 (0.7-3.1) | |||
| align="center" | 1.5 ± 0.5 (0.5-2.5) | |||
| align="center" | 0.9 ± 0.4 (0.1-1.7) | |||
|- | |||
| colspan="5" | <ul> | |||
<li>Data are expressed as mean ± SD (95% confidence interval). Note that for e´ velocity in subjects aged 16 to 20 years, values overlap with those for subjects aged 21 to 40 years. This is because e´ increases progressively with age in children and adolescents. Therefore, the e´ velocity is higher in a normal 20-year-old than in a normal 16-year-old, which results in a somewhat lower average e´ value when subjects aged 16 to 20 years are considered.</li> | |||
<li><sup>∗</sup> Standard deviations are not included because these data were computed, not directly provided in the original articles from which they were derived.</li> | |||
</ul> | |||
|} | |||
==Left Ventricular Mass and Geometry== | ==Left Ventricular Mass and Geometry== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
| Line 230: | Line 400: | ||
|} | |} | ||
== | =Right Ventricle= | ||
==Right Ventricular and Pulmonary Artery Size== | ==Right Ventricular and Pulmonary Artery Size== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
| Line 397: | Line 502: | ||
|- | |- | ||
| colspan=" | | TAPSE, (cm) | ||
| align="center" | 1.5-2.0<cite>ASE</cite> | |||
| align="center" | 1.3-1.5<cite>Hamer</cite> | |||
| align="center" | 1.0-1.2<cite>Hamer</cite> | |||
| align="center" | <1.0<cite>Hamer</cite> | |||
|- | |||
| colspan="6" | | |||
<ul> | <ul> | ||
<li>RV, Right ventricular.</li> | <li>RV, Right ventricular.</li> | ||
| Line 405: | Line 517: | ||
|} | |} | ||
=Atria= | |||
==Left Atrial Dimensions / Volumes== | ==Left Atrial Dimensions / Volumes== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
| Line 518: | Line 631: | ||
|} | |} | ||
==Left Atrial Pressure== | |||
[[File:LAP_normalEF.svg|thumb|left|400px|Estimation of left atrial pressure in normal LVEF. After <cite>ASEDF</cite>]] | |||
[[File:LAP_reducedEF.svg|thumb|400px|Estimation of left atrial pressure in reduced LVEF. After <cite>ASEDF</cite>]] | |||
{{clr}} | |||
=Aortic Valve= | |||
== | ==Aortic valve stenosis - severity== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+'''Recommendations for classification of AS severity''' | |+'''Recommendations for classification of AS severity<cite>ASEVS</cite>''' | ||
|- | |- | ||
| Line 569: | Line 686: | ||
|- | |- | ||
| colspan="5" |<ul> | | colspan="5" |<ul> | ||
<li><sup>a</sup>ESC Guidelines.</li> | <li><sup>a</sup>ESC Guidelines.<cite>ESCAS</cite></li> | ||
<li><sup>b</sup>AHA/ACC Guidelines.</li> | <li><sup>b</sup>AHA/ACC Guidelines.<cite>AHAAS</cite></li> | ||
</ul> | |||
|} | |||
==Aortic regurgitation - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of aortic regurgitation severity<cite>ASERE</cite>''' | |||
|- | |||
! style="width:160px" | | |||
! style="width:250px" | Mild | |||
! colspan="2" | Moderate | |||
! style="width:250px" | Severe | |||
|- | |||
! Specific signs for AR severity | |||
| style="vertical-align:top" | <ul> | |||
<li>Central Jet, width < 25% of LVOT<sup>ς</sup></li> | |||
<li>Vena contracta < 0.3 cm<sup>ς</sup></li> | |||
<li>No or brief early diastolic flow reversal in descending aorta</li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Signs of AR>mild present but no criteria for severe AR</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Central Jet, width ≥ 65% of LVOT<sup>ς</sup></li> | |||
<li>Vena contracta > 0.6cm<sup>ς</sup></li> | |||
</ul> | |||
|- | |||
! Supportive signs | |||
| style="vertical-align:top" | <ul> | |||
<li>Pressure half-time > 500 ms</li> | |||
<li>Normal LV size<sup>∗</sup></li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate values</li></ul> | |||
| <ul> | |||
<li>Pressure half-time < 200 ms</li> | |||
<li>Holodiastolic aortic flow reversal in descending aorta</li> | |||
<li>Moderate or greater LV enlargement<sup>∗∗</sup></li> | |||
</ul> | |||
|- | |||
| colspan="5" | '''Quantitative parameters<sup>ψ</sup>''' | |||
|- | |||
| style="padding-left:12px" | R Vol, ml/beat | |||
| align="center" | < 30 | |||
| align="center" style="width:125px" | 30-44 | |||
| align="center" style="width:125px" | 45-59 | |||
| align="center" | ≥ 60 | |||
|- | |||
| style="padding-left:12px" | RF % | |||
| align="center" | < 30 | |||
| align="center" | 30-39 | |||
| align="center" | 40-49 | |||
| align="center" | ≥ 50 | |||
|- | |||
| style="padding-left:12px" | EROA, cm<sup>2</sup> | |||
| align="center" | < 0.10 | |||
| align="center" | 0.10-0.19 | |||
| align="center" | 0.20-0.29 | |||
| align="center" | ≥ 0.30 | |||
|- | |||
| colspan="5" | | |||
<ul> | |||
<li><em>AR</em>, Aortic regurgitation; <em>EROA</em>, effective regurgitant orifice area; <em>LV</em>, left ventricle; <em>LVOT</em>, left ventricular outflow tract; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li> | |||
<li><sup>∗</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor-axis ≤ 2.8 cm/m<sup>2</sup>, LV end-diastolic volume ≤ 82 ml/m<sup>2</sup> (2).</li> | |||
<li><sup>ς</sup> At a Nyquist limit of 50–60 cm/s.</li> | |||
<li><sup>∗∗</sup> In the absence of other etiologies of LV dilatation.</li> | |||
<li><sup>ψ</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.</li> | |||
</ul> | </ul> | ||
|} | |} | ||
== | |||
=Mitral Valve= | |||
==Mitral regurgitation - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of mitral regurgitation severity<cite>ASERE</cite>''' | |||
|- | |||
! style="width:160px" | | |||
! style="width:250px" | Mild | |||
! colspan="2" | Moderate | |||
! style="width:250px" | Severe | |||
|- | |||
! Specific signs of severity | |||
| style="vertical-align:top" | <ul> | |||
<li>Small central jet <4 cm<sup>2</sup> or <20% of LA area<sup>ψ</sup></li> | |||
<li>Vena contracta width <0.3 cm</li> | |||
<li>No or minimal flow convergence</li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Signs of MR>mild present, but no criteria for severe MR</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Vena contracta width ≥ 0.7cm <em>with</em> large central MR jet (area < 40% of LA) or with a wall-impinging jet of any size, swirling in LA<sup>ψ</sup></li> | |||
<li>Large flow convergence<sup>ς</sup></li> | |||
<li>Systolic reversal in pulmonary veins</li> | |||
<li>Prominent flail MV leaflet or ruptured papillary muscle</li> | |||
</ul> | |||
|- | |||
! Supportive signs | |||
| style="vertical-align:top" | <ul> | |||
<li>Systolic dominant flow in pulmonary veins</li> | |||
<li>A-wave dominant mitral inflow<sup>Φ</sup></li> | |||
<li>Soft density, parabolic CW Doppler MR signal</li> | |||
<li>Normal LV size<sup>∗</sup></li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate signs/findings</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Dense, triangular CW Doppler MR jet</li> | |||
<li>E-wave dominant mitral inflow (E >1.2 m/s)<sup>Φ</sup> Enlarged LV and LA size<sup>∗∗</sup>, (particularly when normal LV function is present).</li> | |||
</ul> | |||
|- | |||
| colspan="5" | '''Quantitative parameters<sup>φ</sup>''' | |||
|- | |||
| style="padding-left:12px" | R Vol (ml/beat) | |||
| align="center" | < 30 | |||
| style="width:125px" align="center" | 30-44 | |||
| style="width:125px" align="center" | 45-59 | |||
| align="center" | ≥ 60 | |||
|- | |||
| style="padding-left:12px" | RF (%) | |||
| align="center" | < 30 | |||
| align="center" | 30-39 | |||
| align="center" | 40-49 | |||
| align="center" | ≥ 50 | |||
|- | |||
| style="padding-left:12px" | EROA (cm<sup>2</sup>) | |||
| align="center" | < 0.20 | |||
| align="center" | 0.20-0.29 | |||
| align="center" | 0.30-0.39 | |||
| align="center" | ≥ 0.40 | |||
|- | |||
| colspan="5" | <ul> | |||
<li><em>CW</em>, Continuous wave; <em>EROA</em>, effective regurgitant orifice area; <em>LA</em>, left atrium; <em>LV</em>, left ventricle; <em>MV</em>, mitral valve; <em>MR</em>, mitral regurgitation; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li> | |||
<li><sup>∗</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor axis ≤ 2.8 cm/m<sup>2</sup>, LV end-diastolic volume ≤ 82 ml/m<sup>2</sup>, maximal LA antero-posterior diameter ≤ 2.8 cm/m<sup>2</sup>, maximal LA volume ≤ 36 ml/m<sup>2</sup> (2;33;35).</li> | |||
<li><sup>∗∗</sup> In the absence of other etiologies of LV and LA dilatation and acute MR.</li> | |||
<li><sup>ψ</sup> At a Nyquist limit of 50-60 cm/s.</li> | |||
<li><sup>Φ</sup> Usually above 50 years of age or in conditions of impaired relaxation, in the absence of mitral stenosis or other causes of elevated LA pressure.</li> | |||
<li><sup>ς</sup> Minimal and large flow convergence defined as a flow convergence radius < 0.4 cm and ≤ 0.9 cm for central jets, respectively, with a baseline shift at a Nyquist of 40 cm/s; Cut-offs for eccentric jets are higher, and should be angle corrected (see text).</li> | |||
<li><sup>φ</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe as shown.</li> | |||
</ul> | |||
|} | |||
==Mitral stenosis - severity== | |||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+'''Assessment of mitral valve anatomy according to the Wilkins score< | |+'''Recommendations for classification of mitral stenosis severity<cite>ASEVS</cite>''' | ||
|- | |||
! style="width:200px" | | |||
! style="width:80px" | Mild | |||
! style="width:80px" | Moderate | |||
! style="width:80px" | Severe | |||
|- | |||
| colspan="4" | '''Specific findings''' | |||
|- | |||
| style="padding-left:12px" | Valve area (cm<sup>2</sup>) | |||
| align="center" | >1.5 | |||
| align="center" | 1.0-1.5 | |||
| align="center" | <1.0 | |||
|- | |||
| colspan="4" | '''Supportive findings''' | |||
|- | |||
| style="padding-left:12px" | Mean gradient (mmHg)<sup>a</sup> | |||
| align="center" | <5 | |||
| align="center" | 5-10 | |||
| align="center" | >10 | |||
|- | |||
| style="padding-left:12px" | Pulmonary artery pressure (mmHg) | |||
| align="center" | <30 | |||
| align="center" | 30-50 | |||
| align="center" | >50 | |||
|- | |||
| colspan="4" | <ul><li><sup>a</sup>At heart rates between 60 and 80 bpm and in sinus rhythm.</li></ul> | |||
|} | |||
==Mitral valve stenosis - Wilkins score== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Assessment of mitral valve anatomy according to the Wilkins score<cite>Wilkins</cite>''' | |||
|- | |- | ||
| Line 618: | Line 924: | ||
| colspan="5" |<ul><li>The total score is the sum of the four items and ranges between 4 and 16.</li></ul> | | colspan="5" |<ul><li>The total score is the sum of the four items and ranges between 4 and 16.</li></ul> | ||
|} | |||
==Mitral stenosis - routine measurements== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Recommendations for data recording and measurement in routine use for mitral stenosis quantitation<cite>ASEVS</cite>''' | |||
|- | |||
! Data element | |||
! Recording | |||
! Measurement | |||
|- | |||
! rowspan="5" | Planimetry | |||
|- | |||
| style="vertical-align:top; " | - 2D parasternal short-axis view | |||
| style="vertical-align:top; " | - contour of the inner mitral orifice | |||
|- | |||
| style="vertical-align:top; " | - determine the smallest orifice by scanning from apex to base | |||
| style="vertical-align:top; " | - include commissures when opened | |||
|- | |||
| style="vertical-align:top; " | - positioning of measurement plan can be oriented by 3D echo | |||
| style="vertical-align:top; " | - in mid-diastole (use cine-loop) | |||
|- | |||
| style="vertical-align:top" | - lowest gain setting to visualize the whole mitral orifice | |||
| style="vertical-align:top" | - average measurements if atrial fibrillation | |||
|- | |||
! rowspan="4" | Mitral flow | |||
|- | |||
| style="vertical-align:top; " | - continuous-wave Doppler | |||
| style="vertical-align:top; " | - mean gradient from the traced contour of the diastolic mitral flow | |||
|- | |||
| style="vertical-align:top; " | - apical windows often suitable (optimize intercept angle) | |||
| style="vertical-align:top; " | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear) | |||
|- | |||
| style="vertical-align:top" | - adjust gain setting to obtain well-defined flow contour | |||
| style="vertical-align:top" | - average measurements if atrial fibrillation | |||
|- | |||
! rowspan="3" | Systolic pulmonary artery pressure | |||
|- | |||
| style="vertical-align:top; " | - continuous-wave Doppler | |||
| style="vertical-align:top; " | - maximum velocity of tricuspid regurgitant flow | |||
|- | |||
| style="vertical-align:top" | - multiple acoustic windows to optimize intercept angle | |||
| style="vertical-align:top" | - estimation of right atrial pressure according to inferior vena cava diameter | |||
|- | |||
! rowspan="8" | Valve anatomy | |||
|- | |||
| rowspan="2" style="vertical-align:top; " | | |||
- parasternal short-axis view | |||
|- | |||
| style="vertical-align:top; " | | |||
- valve thickness (maximum and heterogeneity)<br> | |||
- commissural fusion<br> | |||
- extension and location of localized bright zones (fibrous nodutes or calcification) | |||
|- | |||
| rowspan="2" style="vertical-align:top; " | | |||
- parasternal long-axis view | |||
|- | |||
| style="vertical-align:top; " | | |||
- valve thickness<br> | |||
- extension of calcification<br> | |||
- valve pliability<br> | |||
- subvalvular apparatus (chordal thickening, fusion, or shortening) | |||
|- | |||
| rowspan="2" style="vertical-align:top" | - apical two-chamber view | |||
|- | |||
| style="vertical-align:top; " | - subvalvular apparatus (chordal thickening, fusion, or shortening)<br> | |||
|- | |||
| colspan="2"| | |||
Detail each component and summarize in a score | |||
|} | |||
=Tricuspid Valve= | |||
==Tricuspid regurgitation - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Echocardiographic and Doppler parameters used in grading tricuspid regurgitation severity<cite>ASERE</cite>''' | |||
|- | |||
! style="width:200px" | Parameter | |||
! style="width:200px" | Mild | |||
! style="width:200px" | Moderate | |||
! style="width:200px" | Severe | |||
|- | |||
| Tricuspid valve | |||
| Usually normal | |||
| Normal or abnormal | |||
| Abnormal/Flail leaflet/Poor coaptation | |||
|- | |||
| RV/RA/IVC size | |||
| Normal<sup>∗</sup> | |||
| Normal or dilated | |||
| Usually dilated<sup>∗∗</sup> | |||
|- | |||
| Jet area-central jets (cm<sup>2</sup>)<sup>§</sup> | |||
| < 5 | |||
| 5-10 | |||
| > 10 | |||
|- | |||
| VC width (cm)<sup>Φ</sup> | |||
| Not defined | |||
| Not defined, but < 0.7 | |||
| > 0.7 | |||
|- | |||
| PISA radius (cm)<sup>ψ</sup> | |||
| ≤ 0.5 | |||
| 0.6-0.9 | |||
| > 0.9 | |||
|- | |||
| Jet density and contour–CW | |||
| Soft and parabolic | |||
| Dense, variable contour | |||
| Dense, triangular with early peaking | |||
|- | |||
| Hepatic vein flow† | |||
| Systolic dominance | |||
| Systolic blunting | |||
| Systolic reversal | |||
|- | |||
| colspan="4" | | |||
<ul> | |||
<li><em>CW</em>, Continuous wave Doppler; <em>IVC</em>, inferior vena cava; <em>RA</em>, right atrium; <em>RV</em>, right ventricle; <em>VC</em>, vena contracta width.</li> | |||
<li><sup>∗</sup> Unless there are other reasons for RA or RV dilation. Normal 2D measurements from the apical 4-chamber view: RV medio-lateral end-diastolic dimension ≤ 4.3 cm, RV end-diastolic area ≤ 35.5 cm<sup>2</sup>, maximal RA medio-lateral and supero-inferior dimensions ≤ 4.6 cm and 4.9 cm respectively, maximal RA volume ≤ 33 ml/m<sup>2</sup>(35;89).</li> | |||
<li><sup>∗∗</sup> Exception: acute TR.</li> | |||
<li><sup>§</sup> At a Nyquist limit of 50-60 cm/s. Not valid in eccentric jets. Jet area is not recommended as the sole parameter of TR severity due to its dependence on | |||
hemodynamic and technical factors.</li> | |||
<li><sup>Φ</sup> At a Nyquist limit of 50-60 cm/s.</li> | |||
<li><sup>ψ</sup> Baseline shift with Nyquist limit of 28 cm/s.</li> | |||
<li>† Other conditions may cause systolic blunting (eg. atrial fibrillation, elevated RA pressure).</li> | |||
</ul> | |||
|} | |} | ||
==References= | ==Tricuspid stenosis - severity== | ||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Findings indicative of haemodynamically significant tricuspid stenosis<cite>ASEVS</cite>''' | |||
|- | |||
| colspan="2" | '''Specific findings''' | |||
|- | |||
| style="width:190px; padding-left:12px" | Mean pressure gradient | |||
| style="width:80px" | ≥5 mmHg | |||
|- | |||
| style="padding-left:12px" | Inflow time-velocity integral | |||
| >60 cm | |||
|- | |||
| style="padding-left:12px" | <em>T</em><sub>1/2</sub> | |||
| ≥190 ms | |||
|- | |||
| style="padding-left:12px" | Valve area by continuity equation<sup>a</sup> | |||
| ≤1 cm<sup>2</sup> | |||
|- | |||
| colspan="2" | '''Supportive findings''' | |||
|- | |||
| style="padding-left:12px" | Enlarged right atrium ≥moderate | |||
| | |||
|- | |||
| style="padding-left:12px" | DHated inferior vena cava | |||
| | |||
|- | |||
| colspan="2" | <ul> | |||
<li><sup>a</sup>Stroke volume derived from left or right ventricular outflow. In the presence of more than mild TR, the derived valve area will be underestimated. Nevertheless, a value ≤1 cm<sup>2</sup> implies a significant haemodynamic burden imposed by the combined lesion. | |||
</li> | |||
</ul> | |||
|} | |||
=Pulmonary Valve= | |||
==Pulmonary regurgitaion - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Echocardiographic and Doppler parameters used in grading pulmonary regurgitation severity<cite>ASERE</cite>''' | |||
|- | |||
! style="width:200px" | Parameter | |||
! style="width:200px" | Mild | |||
! style="width:200px" | Moderate | |||
! style="width:200px" | Severe | |||
|- | |||
| Pulmonic valve | |||
| Normal | |||
| Normal or abnormal | |||
| Abnormal | |||
|- | |||
| RV size | |||
| Normal<sup>∗</sup> | |||
| Normal or dilated | |||
| Dilated | |||
|- | |||
| Jet size by color Doppler<sup>§</sup> | |||
| Thin (usually < 10 mm in length) with a narrow origin | |||
| Intermediate | |||
| Usually large, with a wide origin; May be brief in duration | |||
|- | |||
| Jet density and deceleration rate –CW† | |||
| Soft; Slow deceleration | |||
| Dense; variable deceleration | |||
| Dense; steep deceleration, early termination of diastolic flow | |||
|- | |||
| Pulmonic systolic flow compared to systemic flow –PW<sup>φ</sup> | |||
| Slightly increased | |||
| Intermediate | |||
| Greatly increased | |||
|- | |||
| colspan="4" | | |||
<ul> | |||
<li><em>CW</em>, Continuous wave Doppler; <em>PR</em>, pulmonic regurgitation; <em>PW</em>, pulsed wave Doppler; <em>RA</em>, right atrium; <em>RF</em>, regurgitant fraction; <em>RV</em>, right ventricle.</li> | |||
<li><sup>∗</sup> Unless there are other reasons for RV enlargement. Normal 2D measurements from the apical 4-chamber view; RV medio-lateral end-diastolic dimension ≤ 4.3 cm, RV end-diastolic area ≤ 35.5 cm<sup>2</sup>(89).</li> | |||
<li><sup>∗∗</sup> Exception: acute PR</li> | |||
<li><sup>§</sup> At a Nyquist limit of 50-60 cm/s.</li> | |||
<li><sup>φ</sup> Cut-off values for regurgitant volume and fraction are not well validated.</li> | |||
<li>† Steep deceleration is not specific for severe PR.</li> | |||
</ul> | |||
|} | |||
==Pulmonary stenosis - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Grading of pulmonary stenosis<cite>ASEVS</cite>''' | |||
|- | |||
! style="width:150px" | | |||
! style="width:80px" | Mild | |||
! style="width:80px" | Moderate | |||
! style="width:80px" | Severe | |||
|- | |||
| Peak velocity (m/s) | |||
| align="center" | <3 | |||
| align="center" | 3-4 | |||
| align="center" | >4 | |||
|- | |||
| Peak gradient (mmHg) | |||
| align="center" | <36 | |||
| align="center" | 36-64 | |||
| align="center" | >64 | |||
|} | |||
=References= | |||
Click on the reference to link directly to the manuscript | |||
<biblio> | <biblio> | ||
#Foale pmid=3730205 | #Foale pmid=3730205 | ||
#Weyman isbn=0812112075 | #Weyman isbn=0812112075 | ||
#ASE pmid=16458610 | #ASE pmid=16458610 | ||
#ASEVS pmid=19130998 | |||
#Wilkins pmid=3190958 | |||
#ESCAS pmid=17259184 | |||
#ACCAS pmid=18848134 | |||
#ASERE pmid=12835667 | |||
#ASEDF pmid=19187853 | |||
#Hamer isbn=9031362352 | |||
</bilbio> | </bilbio> | ||
==External links== | |||
* [https://www.techmed.sk/en/echo/normal-values/ Normal echocardiography values - all measurements (TECHmED)] | |||