Normal Values: Difference between revisions
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Revision as of 09:12, 17 September 2009
Below an up-to-date list of echocardiographic normal values.
Left Ventricle
Left Ventricular Systolic Function
Women | Men | |||||||
---|---|---|---|---|---|---|---|---|
Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | |
Linear method | ||||||||
Endocardial fractional shortening, % | 27–45 | 22–26 | 17–21 | ≤16 | 25–43 | 20–24 | 15–19 | ≤14 |
Midwall fractional shortening, % | 15–23 | 13–14 | 11–12 | ≤10 | 14–22 | 12–13 | 10–11 | ≤10 |
2D Method | ||||||||
Ejection fraction, % | ≥55 | 45–54 | 30–44 | <30 | ≥55 | 45–54 | 30–44 | <30 |
|
Left Ventricular Diastolic Function
![](/images/thumb/d/d9/Diastolicfunction.svg/500px-Diastolicfunction.svg.png)
Practical approach to LV diastolic function grading. Ater [2]
Age group (y) | ||||
---|---|---|---|---|
Measurement | 16-20 | 21-40 | 41-60 | >60 |
IVRT (ms) | 50 ± 9 (32-68) | 67 ± 8 (51-83) | 74 ± 7 (60-88) | 87 ± 7 (73-101) |
E/A ratio | 1.88 ± 0.45 (0.98-2.78) | 1.53 ± 0.40 (0.73-2.33) | 1.28 ± 0.25 (0.78-1.78) | 0.96 ± 0.18 (0.6-1.32) |
DT (ms) | 142 ± 19 (104-180) | 166 ± 14 (138-194) | 181 ± 19 (143-219) | 200 ± 29 (142-258) |
A duration (ms) | 113 ± 17 (79-147) | 127 ± 13 (101-153) | 133 ± 13 (107-159) | 138 ± 19 (100-176) |
PV S/D ratio | 0.82 ± 0.18 (0.46-1.18) | 0.98 ± 0.32 (0.34-1.62) | 1.21 ± 0.2 (0.81-1.61) | 1.39 ± 0.47 (0.45-2.33) |
PV Ar (cm/s) | 16 ± 10 (1-36) | 21 ± 8 (5-37) | 23 ± 3 (17-29) | 25 ± 9 (11-39) |
PV Ar duration (ms) | 66 ± 39 (1-144) | 96 ± 33 (30-162) | 112 ± 15 (82-142) | 113 ± 30 (53-173) |
Septal e´ (cm/s) | 14.9 ± 2.4 (10.1-19.7) | 15.5 ± 2.7 (10.1-20.9) | 12.2 ± 2.3 (7.6-16.8) | 10.4 ± 2.1 (6.2-14.6) |
Septal e´/a´ ratio | 2.4∗ | 1.6 ± 0.5 (0.6-2.6) | 1.1 ± 0.3 (0.5-1.7) | 0.85 ± 0.2 (0.45-1.25) |
Lateral e´ (cm/s) | 20.6 ± 3.8 (13-28.2) | 19.8 ± 2.9 (14-25.6) | 16.1 ± 2.3 (11.5-20.7) | 12.9 ± 3.5 (5.9-19.9) |
Lateral e´/a´ ratio | 3.1∗ | 1.9 ± 0.6 (0.7-3.1) | 1.5 ± 0.5 (0.5-2.5) | 0.9 ± 0.4 (0.1-1.7) |
|
Left Ventricular Mass and Geometry
Women | Men | |||||||
---|---|---|---|---|---|---|---|---|
Reference range |
Mildly abnormal |
Moderately abnormal |
Severely abnormal |
Reference range |
Mildly abnormal |
Moderately abnormal |
Severely abnormal | |
Linear Method | ||||||||
LV mass, g | 67–162 | 163–186 | 187–210 | ≥211 | 88–224 | 225–258 | 259–292 | ≥293 |
LV mass/BSA, g/m2 | 43–95 | 96–108 | 109–121 | ≥122 | 49–115 | 116–131 | 132–148 | ≥149 |
LV mass/height, g/m | 41–99 | 100–115 | 116–128 | ≥129 | 52–126 | 127–144 | 145–162 | ≥163 |
LV mass/height2, g/m2 | 18–44 | 45–51 | 52–58 | ≥59 | 20–48 | 49–55 | 56–63 | ≥64 |
Relative wall thickness, cm | 0.22–0.42 | 0.43–0.47 | 0.48–0.52 | ≥0.53 | 0.24–0.42 | 0.43–0.46 | 0.47–0.51 | ≥0.52 |
Septal thickness, cm | 0.6–0.9 | 1.0–1.2 | 1.3–1.5 | ≥1.6 | 0.6–1.0 | 1.1–1.3 | 1.4–1.6 | ≥1.7 |
Posterior wall thickness, cm | 0.6–0.9 | 1.0–1.2 | 1.3–1.5 | ≥1.6 | 0.6–1.0 | 1.1–1.3 | 1.4–1.6 | ≥1.7 |
2D Method | ||||||||
LV mass, g | 66–150 | 151–171 | 172–182 | >193 | 96–200 | 201–227 | 228–254 | >255 |
LV mass/BSA, g/m2 | 44–88 | 89–100 | 101–112 | ≥113 | 50–102 | 103–116 | 117–130 | ≥131 |
|
Left Ventricular Size
Women | Men | |||||||
---|---|---|---|---|---|---|---|---|
Reference range |
Mildly abnormal |
Moderately abnormal |
Severely abnormal |
Reference range |
Mildly abnormal |
Moderately abnormal |
Severely abnormal | |
LV dimension | ||||||||
LV diastolic diameter | 3.9–5.3 | 5.4–5.7 | 5.8–6.1 | ≥6.2 | 4.2–5.9 | 6.0–6.3 | 6.4–6.8 | ≥6.9 |
LV diastolic diameter/BSA, cm/m2 | 2.4–3.2 | 3.3–3.4 | 3.5–3.7 | ≥3.8 | 2.2–3.1 | 3.2–3.4 | 3.5–3.6 | ≥3.7 |
LV diastolic diameter/height, cm/m | 2.5–3.2 | 3.3–3.4 | 3.5–3.6 | ≥3.7 | 2.4–3.3 | 3.4–3.5 | 3.6–3.7 | ≥3.8 |
LV volume | ||||||||
LV diastolic volume, mL | 56–104 | 105–117 | 118–130 | ≥131 | 67–155 | 156–178 | 179–201 | ≥201 |
LV diastolic volume/BSA, mL/m2 | 35–75 | 76–86 | 87–96 | ≥97 | 35–75 | 76–86 | 87–96 | ≥97 |
LV systolic volume, mL | 19–49 | 50–59 | 60–69 | ≥70 | 22–58 | 59–70 | 71–82 | ≥83 |
LV systolic volume/BSA, mL/m2 | 12–30 | 31–36 | 37–42 | ≥43 | 12–30 | 31–36 | 37–42 | ≥43 |
|
Right Ventricle
Right Ventricular and Pulmonary Artery Size
Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | |
---|---|---|---|---|
RV dimensions | ||||
Basal RV diameter (RVD 1), cm | 2.0–2.8 | 2.9–3.3 | 3.4–3.8 | ≥3.9 |
Mid-RV diameter (RVD 2), cm | 2.7–3.3 | 3.4–3.7 | 3.8–4.1 | ≥4.2 |
Base-to-apex length (RVD 3), cm | 7.1–7.9 | 8.0–8.5 | 8.6–9.1 | ≥9.2 |
RVOT diameters | ||||
Above aortic valve (RVOT 1), cm | 2.5–2.9 | 3.0–3.2 | 3.3–3.5 | ≥3.6 |
Above pulmonic valve (RVOT 2), cm | 1.7–2.3 | 2.4–2.7 | 2.8–3.1 | ≥3.2 |
PA diameter | ||||
Below pulmonic valve (PA 1), cm | 1.5–2.1 | 2.2–2.5 | 2.6–2.9 | ≥3.0 |
|
Right Ventricular Size and Function
Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | ||
---|---|---|---|---|---|
RV diastolic area, cm2 | 11–28 | 29–32 | 33–37 | ≥38 | |
RV systolic area, cm2 | 7.5–16 | 17–19 | 20–22 | ≥23 | |
RV fractional area change, % | 32–60 | 25–31 | 18–24 | ≤17 | |
TAPSE, (cm) | 1.5-2.0[1] | ||||
|
Atria
Left Atrial Dimensions / Volumes
Women | Men | |||||||
---|---|---|---|---|---|---|---|---|
Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | |
Atrial dimensions
| ||||||||
LA diameter, cm | 2.7–3.8 | 3.9–4.2 | 4.3–4.6 | ≥4.7 | 3.0–4.0 | 4.1–4.6 | 4.7–5.2 | ≥5.2 |
LA diameter/BSA, cm/m2 | 1.5–2.3 | 2.4–2.6 | 2.7–2.9 | ≥3.0 | 1.5–2.3 | 2.4–2.6 | 2.7–2.9 | ≥3.0 |
RA minor-axis dimension, cm | 2.9–4.5 | 4.6–4.9 | 5.0–5.4 | ≥5.5 | 2.9–4.5 | 4.6–4.9 | 5.0–5.4 | ≥5.5 |
RA minor-axis dimension/BSA, cm/m2 | 1.7–2.5 | 2.6–2.8 | 2.9–3.1 | ≥3.2 | 1.7–2.5 | 2.6–2.8 | 2.9–3.1 | ≥3.2 |
Atrial area | ||||||||
LA area, cm2 | ≤20 | 20–30 | 30–40 | >40 | ≤20 | 20–30 | 30–40 | >40 |
Atrial volumes | ||||||||
LA volume, mL | 22–52 | 53–62 | 63–72 | ≥73 | 18–58 | 59–68 | 69–78 | ≥79 |
LA volume/BSA, mL/m2 | 22 ± 6 | 29–33 | 34–39 | ≥40 | 22 ± 6 | 29–33 | 34–39 | ≥40 |
|
Left Atrial Pressure
![](/images/thumb/b/be/LAP_normalEF.svg/400px-LAP_normalEF.svg.png)
Estimation of left atrial pressure in normal LVEF. After [2]
![](/images/thumb/1/1c/LAP_reducedEF.svg/400px-LAP_reducedEF.svg.png)
Estimation of left atrial pressure in reduced LVEF. After [2]
Aortic Valve
Aortic valve stenosis - severity
Aortic sclerosis | Mild | Moderate | Severe | |
---|---|---|---|---|
Aortic jet velocity (m/s) | ≤2.5 m/s | 2.6-2.9 | 3.0-4.0 | >4.0 |
Mean gradient (mmHg) | - | <20 (<30a) | 20-40b (30-50a) | >40b (>50a) |
AVA (cm2) | - | >1.5 | 1.0-1.5 | <1 |
Indexed AVA (cm2/m2) | >0.85 | 0.60-0.85 | <0.6 | |
Velocity ratio | >0.50 | 0.25-0.50 | <0.25 | |
Aortic regurgitation - severity
Mild | Moderate | Severe | ||
---|---|---|---|---|
Specific signs for AR severity |
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Supportive signs |
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Quantitative parametersψ | ||||
R Vol, ml/beat | < 30 | 30-44 | 45-59 | ≥ 60 |
RF % | < 30 | 30-39 | 40-49 | ≥ 50 |
EROA, cm2 | < 0.10 | 0.10-0.19 | 0.20-0.29 | ≥ 0.30 |
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Mitral Valve
Mitral regurgitation - severity
Mild | Moderate | Severe | ||
---|---|---|---|---|
Specific signs of severity |
|
|
| |
Supportive signs |
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| |
Quantitative parametersφ | ||||
R Vol (ml/beat) | < 30 | 30-44 | 45-59 | ≥ 60 |
RF (%) | < 30 | 30-39 | 40-49 | ≥ 50 |
EROA (cm2) | < 0.20 | 0.20-0.29 | 0.30-0.39 | ≥ 0.40 |
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Mitral stenosis - severity
Mild | Moderate | Severe | |
---|---|---|---|
Specific findings | |||
Valve area (cm2) | >1.5 | 1.0-1.5 | <1.0 |
Supportive findings | |||
Mean gradient (mmHg)a | <5 | 5-10 | >10 |
Pulmonary artery pressure (mmHg) | <30 | 30-50 | >50 |
|
Mitral valve stenosis - Wilkins score
Grade | Mobility | Thickening | Calcification | Subvalvular Thickening |
---|---|---|---|---|
1 | Highly mobile valve with only leaflet tips restricted | Leaflets near normal in thickness (4-5 mm) | A single area of increased echo brightness | Minimal thickening just below the mitral leaflets |
2 | Leaflet mid and base portions have normal mobility | Midleaflets normal, considerable thickening of margins (5-8 mm) | Scattered areas of brightness confined to leaflet margins | Thickening of chordal structures extending to one-third of the chordal length |
3 | Valve continues to move forward in diastole, mainly from the base | Thickening extending through the entire leaflet (5-8mm) | Brightness extending into the mid-portions of the leaflets | Thickening extended to distal third of the chords |
4 | No or minimal forward movement of the leaflets in diastole | Considerable thickening of all leaflet tissue (>8-10mm) | Extensive brightness throughout much of the leaflet tissue | Extensive thickening and shortening of all chordal structures extending down to the papillary muscles |
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Mitral stenosis - routine measurements
Data element | Recording | Measurement |
---|---|---|
Planimetry | ||
- 2D parasternal short-axis view | - contour of the inner mitral orifice | |
- determine the smallest orifice by scanning from apex to base | - include commissures when opened | |
- positioning of measurement plan can be oriented by 3D echo | - in mid-diastole (use cine-loop) | |
- lowest gain setting to visualize the whole mitral orifice | - average measurements if atrial fibrillation | |
Mitral flow | ||
- continuous-wave Doppler | - mean gradient from the traced contour of the diastolic mitral flow | |
- apical windows often suitable (optimize intercept angle) | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear) | |
- adjust gain setting to obtain well-defined flow contour | - average measurements if atrial fibrillation | |
Systolic pulmonary artery pressure | ||
- continuous-wave Doppler | - maximum velocity of tricuspid regurgitant flow | |
- multiple acoustic windows to optimize intercept angle | - estimation of right atrial pressure according to inferior vena cava diameter | |
Valve anatomy | ||
- parasternal short-axis view | ||
- valve thickness (maximum and heterogeneity) | ||
- parasternal long-axis view | ||
- valve thickness | ||
- apical two-chamber view | ||
- subvalvular apparatus (chordal thickening, fusion, or shortening) | ||
Detail each component and summarize in a score |
Tricuspid Valve
Tricuspid regurgitation - severity
Parameter | Mild | Moderate | Severe |
---|---|---|---|
Tricuspid valve | Usually normal | Normal or abnormal | Abnormal/Flail leaflet/Poor coaptation |
RV/RA/IVC size | Normal∗ | Normal or dilated | Usually dilated∗∗ |
Jet area-central jets (cm2)§ | < 5 | 5-10 | > 10 |
VC width (cm)Φ | Not defined | Not defined, but < 0.7 | > 0.7 |
PISA radius (cm)ψ | ≤ 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 |
|
Tricuspid stenosis - severity
Specific findings | |
Mean pressure gradient | ≥5 mmHg |
Inflow time-velocity integral | >60 cm |
T1/2 | ≥190 ms |
Valve area by continuity equationa | ≤1 cm2 |
Supportive findings | |
Enlarged right atrium ≥moderate | |
DHated inferior vena cava | |
|
Pulmonary Valve
Pulmonary regurgitaion - severity
Parameter | Mild | Moderate | Severe |
---|---|---|---|
Pulmonic valve | Normal | Normal or abnormal | Abnormal |
RV size | Normal∗ | Normal or dilated | Dilated |
Jet size by color Doppler§ | 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 –PWφ | Slightly increased | Intermediate | Greatly increased |
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Pulmonary stenosis - severity
Mild | Moderate | Severe | |
---|---|---|---|
Peak velocity (m/s) | <3 | 3-4 | >4 |
Peak gradient (mmHg) | <36 | 36-64 | >64 |
References
Click on the reference to link directly to the manuscript <biblio>
- Foale pmid=3730205
- Weyman isbn=0812112075
- ASE pmid=16458610
- ASEVS pmid=19130998
- Wilkins pmid=3190958
- ESCAS pmid=17259184
- ACCAS pmid=18848134
- ASERE pmid=12835667
- ASEDF pmid=19187853
</bilbio>