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tends to be flat, whereas in smaller curved vessels, the profile has a parabolic shape.

Velocity will be higher at the center and lower at the margins (Figure 3). Fortunately, flow passing through a normal heart valve or the proximal great vessels tends to be laminar with a flat profile and is therefore suitable for quantitative analysis.

Figure 3. Diagrammatic illustration of flat and parabolic flow through a vessel. From J Am Soc Echocardiogr 2002;15:167-84

Physiologic blood flow is never perfectly uniform. That is, at any point in time, a distribution of velocities occurs, resulting in a broadening of the Doppler signal. The greater the range of velocities is at any point in time, the broader is the Doppler signal. The darker line through the center of the distribution represents the modal frequency, i.e., the velocity at which the largest number of blood cells are traveling. When tracing the velocity to derive a VTI, it is best to trace the outer edge of the most dense portion of the spectral tracing (i.e., the modal velocity) and ignore the dispersion that occurs near peak velocity. When measuring TVI, multiple cycles (usually three to five) should be traced and averaged to minimize error. In patients with atrial fibrillation, between five and 10 beats should be analyzed.

Volume measurement
Cardiac chambers volumes are echocardiographic measurements widely used in clinical practice and research. To obtain volumetric measurements, the most important views for 2D quantitation are the midpapillary short-axis view and the apical 4- and 2-chamber views. Volumetric measurements require manual tracing of the endocardial border. Accurate measurements require optimal visualization of the endocardial border to minimize the need for extrapolation. Some formulas have been proposed to calculate left ventricular (LV) volumes from LV linear dimensions, such as the Teichholz or Quinones methods. Unfortunately, linear measures of LV function are problematic when there is a marked regional difference in function, in patients with uncomplicated hypertension, obesity, or valvular diseases, and these methods may result in inaccuracies as a result of the geometric assumptions required to convert a linear measurement to a 3D volume. The most commonly used 2D measurement for volume measurements is the biplane method of disks (modified Simpsons rule), which is the currently recommended method of choice. The principle underlying this method is that the total LV volume is calculated from the summation of a stack of elliptical disks. The height of each disk is calculated as a fraction (usually 1/20) of the LV long axis based on the longer of the two lengths from the 2- and 4chamber views. The cross-sectional area of the disk is based on the two diameters obtained from the 2- and 4-