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Echo-Pocket 2014 2
Echo-Pocket 2014 2
In partnership with
Valve Quantification
Recommendations for the echocardiographic
assessment of native valvular regurgitation: an
executive summary from the European Association of
Cardiovascular Imaging.
Lancelotti et al EHJ-CI 2013; 14:611-644
Guidelines on the management of valvular heart
disease (version 2012). The Joint Task Force on
the Management of Valvular Heart Disease of the
European Society of Cardiology (ESC) and the European
Association for Cardio-Thoracic Surgery(EACTS).
Vahanian et al EHJ 2012; 33:2451-2496
Aortic Dimensions
Adapted from:
Two-dimensional echocardiographic aortic root
dimensions in normal children and adults. Roman MJ
et al. Am J Cardiol 1989;64:50712
Echocardiography in aortic diseases:
EAE recommendations for clinical practice
Evangelista et al EJE 2010; 11:645-658
Valve Quantification
Aortic stenosis
Mild
Moderate
Severe
Peak velocity
(m/s)
<2.9
3.0-3.9
>4.0
Mean pressure
drop (mmHg) <25
25-40
>40
Valve area
(cm2)
1.5-2.0
1.0-1.4
<1.0
Velocity or
VTI ratio
0.5
0.25-0.5
0.25
Valve Quantification
Aortic regurgitation
<0.3
>0.6
<25
65
30
31-59
60
30
31-49
50
0.10 0.11-0.29
>500
End Diastolic Velocity
(upper DAo) (cm/s)
0.30
<200
20
Valve Quantification
Aortic dimensions
4.4
3.8
4.0
rm
al
2.2
Age 20-39 yr
1.6
2.0
2.4
Di
3.0
2.6
ed
lat
Di
3.6
No
3.4
la
te
d
4.2
3.2
2.8
al
rm
No
2.4
Age 40 yr
1.6
2.0
2.4
Valve Quantification
Mitral stenosis
Pressure
half time (ms)
Mild
71-139
Mean pressure
drop (mmHg) <5
Valve area
(cm2)
1.6-2.0
Moderate
Severe
140-219
220
5-10
>10
1.0-1.5
<1.0
Valve Quantification
Mild
Moderate Severe
<0.3
0.7
<0.4
>1.0
30
31-59
60
30
31-49
50
0.21-0.39
0.40
MV Inflow (VTI)/LVOT(VTI)
>1.4
Valve Quantification
Tricuspid regurgitation
VC width (cm)
EROA (mm2)
Mild
Not defined
Moderate Severe
<0.7
>0.7
40
Regurgitant volume
(mL)
45
CW jet density/contour
Soft/
Dense/
parabolic
variable
RA/RV/IVC size
Hepatic vein flow
Dense/
triangular early
peaking
Systolic
blunting
Systolic
reversal
Valve Quantification
Tricuspid stenosis
Severe
>60
<1.0
Pulmonary stenosis
Peak velocity (m/s)
Mild
Moderate
Severe
<3
3-4
>4
Valve Quantification
Pulmonary regurgitation
Severe
>65%
Pressure half-time
Doppler PR index
(duration relative to diastolic cycle)
CF Doppler origin of PR jet.
Doppler timing of PR
<100ms
< 0.77
From bifurcation
of branch PA
Pre-systolic
Valve Quantification
Chamber Quantification
Adapted from:
Recommendations for Chamber Quantification: A
Report from the American Society of Echocardiographys
Guidelines and Standards Committee and the Chamber
Quantification Writing Group, Developed in Conjunction
with the European Association of Echocardiography, a
Branch of the European Society of Cardiology.
Lang RM et al. J Am Soc Echocardiogr 2005; 18:14401463
Right Ventricular Function
Adapted from:
Guidelines for the Echocardiographic Assessment
of the Right Heart in Adults: A Report from the ASE
Endorsed by the EAE, and the CSE. Rudski, LG, et al. J
Am Soc Echocardiogr 2010; 23:685-713.
Chamber Quantification
96-200
50-102
201-227 228-254
103-116 117-130
LV mass, men 2D
LV mass (g)
LV mass / BSA (g/m2)
<15
35
15-19
36-44
20-24
45-54
Chamber Quantification
>254
>130
>193
>112
97
43
87-96
37-42
202
83
131
70
76-86
31-36
151-171 172-193
89-100 101-112
156-178 179-201
71-82
59-70
LV volume, men
67-155
LV diastolic volume (mL)
22-58
LV systolic volume (mL)
LV volume index
LV diastolic volume/BSA (mL/m2) 35-75
LV systolic volume/BSA (mL/m2) 12-30
LV function
25-43
Fractional shortening (%)
55
Ejection fraction (%)
method*
EF by Biplane Simpsons
LV mass, women 2D
66-150
LV mass (g)
44-88
LV mass / BSA (g/m2)
105-117 118-130
60-69
50-59
LV volume, women
56-104
LV diastolic volume (mL)
19-49
LV systolic volume (mL)
6.9
3.7
6.4-6.8
3.5-3.6
6.0-6.3
3.2-3.4
LV dimension, men
LVIDd (cm)
LVIDd / BSA (cm/m2)
4.2-5.9
2.2-3.1
6.2
3.8
5.8-6.1
3.5-3.7
Moderate Severe
2.0
Mild
1.6-1.9
Normal
1.3-1.5
0.6-1.2
LV dimension, women
5.4-5.7
3.9-5.3
LVIDd (cm)
3.3-3.4
2.4-3.2
LVIDd / BSA (cm/m2)
LV wall thickness
IVSd / PWd (cm)
E/A, <1*
DT >230
E/A, A 1-2
DT 130-230
E/A >2**
DT <130
enormal
ereduced
Grade I
Normal
Grade II
***
***
***
e reduced
LA normal or
s/d >1
E/e usually 8#
LA normal**
s/d >1
E/e <8#
LA
s/d <1
E/e usually 13#
Grade III
***
e reduced
LA
s/d <1
E/e >13
*E/A 1 without any additional evidence of diastolic dysfunction can be normal above 60 years of age.
**E/A and/or increased LA size without structural heart diseasecan be seen in young subjects and athletes.
*** Combined with one or more parameters from below. Confidence of categorisation increases with increasing number of corroborative parameters.
# If E/e is between 9 and 12, additional measurements should be used (see text)
Chamber Quantification
Normal
Mild
LA size, women
LA diameter (cm)
2.7-3.8
3.9-4.2
LA volume (mL)
22-52
53-62
LA size, men
LA diameter (cm)
3.0-4.0
4.1-4.6
LA volume (mL)
18-58
59-68
LA size, index
LA diameter (cm/m2) 1.5-2.3
2.4-2.6
2
LA volume (mL/m
)
16-28
29-33
Moderate
Severe
4.3-4.6
63-72
4.7
73
4.7-5.2
69-78
5.3
79
2.7-2.9
34-39
3.0
40
Chamber Quantification
Abnormal
Chamber Quantification
IVC
size (cm)
Respiratory/
sniff variation
<5mmHg
2.1
50%
>15mmHg
>2.1
<50%
Other
RA size
normal
Hepatic Vein Flow systolic dominant systolic reversal
Chamber Quantification
British Heart Foundation 2014, registered charity in England and Wales (225971) and in Scotland (SC039426)