Professional Documents
Culture Documents
Male Female
LVIDd (cm)
Left ventricular
4,2 - 5,8 5,9 - 6,3 6,4 - 6,8 >6,8 3,8 - 5,2 5,3 - 5,6 5,7 - 6,1 >6,1
internal dimension at
end-diastole
LVIDd (cm/m2)
Left ventricular
2,2 - 3,0 3,1 - 3,3 3,4 - 3,6 >3,6 2,3 - 3,1 3,2 - 3,4 3,5 - 3,7 >3,7
internal dimension at
end-diastole
LVIDs (cm)
Left ventricular
2,5 - 4,0 4,1 - 4,3 4,4 - 4,5 >4,5 2,2 - 3,5 3,6 - 3,8 3,9 - 4,1 >4,1
internal dimension at
end-systole
LVIDs (cm/m2)
Left ventricular
1,3 - 2,1 2,2 - 2,3 2,4 - 2,5 >2,5 1,3 - 2,1 2,2 - 2,3 2,4 - 2,6 >2,6
internal dimension at
end-systole
IVSd (cm)
Interventricular
0,6 - 1,0 1,1 - 1,3 1,4 - 1,6 >1,6 0,6 - 0,9 1,0 - 1,2 1,3 - 1,5 >1,5
septum thickness at
end-diastole
PWd (cm)
Left ventricular
posterior wall 0,6 - 1,0 1,1 - 1,3 1,4 - 1,6 >1,6 0,6 - 0,9 1,0 - 1,2 1,3 - 1,5 >1,5
thickness at end-
diastole
RWT
Relative wall 0,24 - 0,42 0,43 - 0,46 0,47 - 0,51 >0,52 0,22 - 0,42 0,43 - 0,47 0,48 - 0,52 >0,53
thickness
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Left ventricle (Mass)
Male Female
LV mass (g) 88 - 224 225 - 258 259 - 292 >292 67 - 162 163 - 186 187 - 210 >210
Left ventricular mass
LV mass (g/m2)
49 - 115 116 - 131 132 - 148 >148 43 - 95 96 - 108 109 - 121 >121
Left ventricular mass
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Male Female
LVEDV (ml)
Left ventricular end-diastole 62 - 150 151 - 174 175 - 200 >200 46 - 106 107 - 120 121 - 130 >130
volume (Biplane)
LVEDV (ml/m2)
Left ventricular end-diastole 34 - 74 75 - 89 90 - 100 >100 29 - 61 62 - 70 71 - 80 >80
volume (Biplane)
LVESV (ml)
Left ventricular end-systole 21 - 61 62 - 73 74 - 85 >85 14 - 42 43 - 55 56 - 67 >67
volume (Biplane)
LVESV (ml/m2)
Left ventricular end-systole 11 - 31 32 - 38 39 - 45 >45 8 - 24 25 - 32 33 - 40 >40
volume (Biplane)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Male Female
LV EF (%)
Left ventricular ejection 52 - 72 41 - 51 30 - 40 <30 54 - 74 41 - 53 30 - 40 <30
fraction (Biplane)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Left ventricle (Geometry)
LV mass(g/m2) RWT
Relative wall
Left ventricular mass
thickness
Description of LV geometry, using at the minimum the four categories of normal geometry, concentric remodelling,
and concentric and eccentric hypertrophy, should be a standard component of the echocardiography report.
Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)
Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)
RWT = 0,42
RWT = 0,32
Mixed Dilated
hypertrophy hypertrophy
Concentric
hypertrophy
LV mass (g/m2)
Physiological Eccentric
hypertrophy hypertrophy
Concentric
remodeling
Normal LV
Eccentric
remodeling
LVEDV (ml/m2)
Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)
1. MV E/e´ >14
2. Septal e´ <7cm/s or
1 positive Lateral e´ <10cm/s 3, 4 positive
3. Vmax TR >2,8m/s
4. LA volume >34ml/m2
2 positive
Mitral inflow
1. MV E/e´ >14
2/3 or 3/3 2/3 or 3/3
2. Vmax TR >2,8m/s
negative positive
3. LA volume >34ml/m2
1 positive and
2 negative 2 positive
1 negative
If symptomatic
Consider CAD, or
proceed to diastolic
stress test
1. LAP indeterminate if only 1 of 3 parameters available. Pulmonary vein S/D ratio <1 applicable to conclude elevated LAP in patients
with depressed LV EF.
Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)
Assessment of LV lling pressures in special populations
Mitral in ow pattern with predominant early LV lling in patients with EFs <50%
IVRT ≤70 msec is speci c (79%)
Pulmonary vein systolic lling fraction ≤40% is speci c (88%)
Sinus tachycardia Average E/e´ >14 (this cutoff has highest speci city but low sensitivity)
When E and A velocities are partially or completely fused, the presence of a
compensatory period after premature beats often leads to separation of E and A
velocities which can be used for assessment of diastolic function
DT (<140 msec)
Restrictive Mitral E/A (>2.5)
cardiomyopathy IVRT (<50 msec has high speci city)
Average E/e´ (>14)
Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Grade III
diastolic dysfunction
Valvular heart disease
Aortic
Mitral Mitral Mitral annular
stenosis,
senosis regurgitation calcification
regurgitation
Heart transplant
1 - Patients with preserved EFs and normal diastolic function commonly have restrictive appearing filling.
2 - No single diastolic parameter appears reliable enough predict graft rejection.
3 - PASP estimation using the TR jet can be helpful as a surrogate measurement of mean LAP in the absence of pulmonary disease.
1 - In patients with first degree AV block, the variables used to evaluate diastolic function and filling pressures likely remain valid as
long as there is no fusion of mitrel E and A velocities.
2 - The accuracy of mitral annular velocities and E/e´ ratio is less in the presence of LBBB, RV pacing, and in patients who have
received cardiac resynchronization therapy.
3 -If only mitral A velocity is present, only TR peak velocity >2.8m/s can be used as an indicator of LV filling pressures.
Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)
ASE recommendations for the evaluation of LV diastolic function by echocardiography: Quick reference (2016)
Right ventricle
Right ventricle (Size)
RVD1basal 25 - 41mm
Right ventricular basal diameter at end-diastole
RVD2mid 19 - 35mm
Right ventricular mid diameter at end-diastole
RVD3long 59 - 83mm
Right ventricular longitudinal diameter at end-diastole
RVOTprox(PLAX) 20 - 30mm
Right ventricular out ow tract at proximal (PLAX)
RVOTprox(PSAX) 21 - 35mm
Right ventricular out ow tract at proximal (PSAX)
RVOTdistal(PSAX) 17 - 27mm
Right ventricular out ow tract at distal (PSAX)
PAdiameter 15 - 25mm
Main pulmonary artery diameter
RVWT 1 - 5mm
Right ventricular wall thickness
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)
Male Female
RV EDA (cm2) 10 - 24 8 - 20
Right ventricular end-diastolic area
RV ESA (cm2) 3 - 15 3 - 11
Right ventricular end-systolic area
RV EDV (ml/m2) 35 - 87 32 - 74
Right ventricular end-diastolic volume
RV ESV (ml/m2) 10 - 44 8 - 36
Right ventricular end-systolic volume
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Right ventricle (Function)
Variable Abnormal
TAPSE <17mm
Tricuspid annular plane systolic excursion
S’ WavepulsedTDI <9,5cm/s
Peak systolic velocity tricuspid annulus (Pulsed TDI)
S’ WavecolorTDI <6cm/s
Peak systolic velocity tricuspid annulus (Color TDI)
FAC <35%
Fractional Area Change
RV EF <45%
Right ventricular ejection fraction
RIMPTDI
Right Ventricular Index of Myocardial Performance >0,54
(TDI)
RIMPPWd
Right Ventricular Index of Myocardial Performance >0,43
(PWd)
IVARV
Myocardial acceleration during isovolumic <1,1m/s2
contraction
PVR >3WU
Pulmonary vascular ressistance
RV dP/dt
<400mmHg/s
Rate of rise of right ventricle pressure
E/ATrV <0,8
Tricuspid valve E / A wave ratio >2
DT TrV <119ms
Tricuspid valve deceleration time >242ms
e´ waveTrV
eak velocity in early diastole of tricuspid annulus <7,8cm/s
(TDI)
e´/a´TrV <0,52
Tricuspid valve e´ / a´ ratio (TDI)
E/e´TrV
>6
Tricuspid valve E / e´ ratio
PAAT
<100ms
Pulmonary artery acceleration time
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)
Right ventricle (Pressure)
Variable Abnormal
RVSP(SPAP)
>35mmHg
Right ventricular systolic pressure
mPAP
>25mmHg
Mean pulmonar arterial pressure
PADP >15mmHg
Pulmonary artery diastolic pressure
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)
Variable Abnormal
RVOTprox(PLAX)
>30mm
Right ventricular out ow tract at proximal (PLAX)
Basal RV/LV
>1
Basal right/left ventricle ratio
D septum
Yes
D shaped septum
IVCdiameter >2,1cm
Inferior vena cava diameter
IVCcollaps <50%
Inferior vena cava collapsibility
McConnel´s sign
Yes
Mid wall hypokinesia and apical hyperkinesia
Trombus RV
Yes
Right heart mobile trombus
TAPSE <16mm
Tricuspid annular plane systolic excursion
S’ wavepulsedTDI <9,5cm/s
Peak systolic velocity tricuspid annulus (Pulsed TDI)
Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)
Regional wall motion abnormality and
segments
Distal septum infarct Supraapical infarct
LAD (distal, mid., prox.) LAD (distal, mid., prox.)
Low remodeling risk Small supraapical aneurysm
A4C, A2C, A3C (Echo views) Low remodeling risk
Supraapical and distal septal infarcts can also occur in proximal LAD occlusion after rapid reperfusion.
Lateral Infarct
CX, LAD (diagonal branch, di cult to
interpret)
Low remodeling risk
When assessing the patterns of myocardial infarction, always consider the possibility of multiple/sequential
infarcts!
Coronary Artery Territories (Echocardiography Illustrated Book 4)
ESSENTIAL ECHOCARDIOGRAPHY A Companion to Braunwald’s Heart Disease
Atria
Left atrium (Size)
Female Male
LA AP (cm)
2,7 - 3,8 3,0 - 4,0
Left atrium anterior-posterior dimension
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Male Female
LA volume (ml/m2)
16 - 34 35 - 41 42 - 48 >48 16 - 34 35 - 41 42 - 48 >48
Left atrial volume (Biplane)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Variable Abnormal
RA major (mm)
>53
Right atrium major axis dimension
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Right atrium (Size, Volume)
Male Female
RA major (cm/m2)
2,4 ±0,3 2,5 ±0,3
Right atrium major axis dimension
RA minor (cm/m2)
1,9 ±0,3 1,9 ±0,3
Right atrium minor axis dimension
RA volume (ml/m2)
25 ±7 21 ±6
Right atrium volume (Single plane)
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
IVCdiameter
<2,1cm <2,1cm >2,1cm >2,1cm
Inferior vena cava diameter
IVCcollaps
>50% <50% >50% <50%
Inferior vena cava collapsibility
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Pericardial effusion
Pericardial effusion (Quanti cation)
Variable Abnormal
IVCdiameter >2,1cm
Inferior vena cava diameter
Recommendations for Cardiac Chamber Quanti cation by Echocardiography in Adults: An Update from the ASE and EACVI (2015)
Aorta
Aorta (Size)
Variable Abnormal
AoA
20 - 31mm
Aortic annulus diameter
AoSV
29 - 45mm
Aortic sinuses of valsalva diameter
AoSTJ 22 - 36mm
Aortic sinotubular junction diameter
AoPxA 22 - 36mm
Proximal ascending aorta diameter
AoArch
22 - 36mm
Aortic arch diameter
AoDesc
20 - 30mm
Descending aorta diameter
Aortic valve
Aortic stenosis
Velocity ratio
>0,5 0,25 - 0,5 <0,25
Aortic valve velocity ratio (Dimensionless index)
Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)
Aortic regurgitation
Structural parameters
Abnormal/ ail, or
Aortic lea ets Normal or abnormal Normal or abnormal wide coaptation
defect
Qualitative doppler
RegJetdensity
Regurgitant jet density Incomplete or faint Dense Dense
(CW doppler)
Diastolic reversal ow
Brief, early diastolic Prominent
in descending aorta (PW Intermediate
doppler)
reversal holodiastolic reversal
Semiquantitative parameters4
VCW (cm)
<0,3 0,3 - 0,6 >0,6
Vena contracta width
Quantitative parameters4
RegVol (ml)
Regurgitant volume of aortic <30 30 - 44 45 - 59 ≥60
regurgitation
Bolded qualitative and semiquantitative signs are considered speci c for their AR grade. Color Doppler usually
performed at a Nyquist limit of 50-70 cm/sec.
≥4 criteria ≥4 criteria
Definitively mild Definitively severe
(quantitation not needed) (may still quantitate)
3 specific criteria
for severe AR
* Speci c ndings
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)
Chronic mitral regurgitation
Structural
Qualitative doppler
Semiquantitative
Quantitative6
EROA (cm2)
<0,2 0,2 - 0,3 0,3 - 0,39 ≥0,4
Effective regurgitant ori ce area
RegVol (ml)
Regurgitant volume of mitral <30 30 - 44 45 - 59 ≥60
regurgitation
RF (%)
Regurgitant fraction of mitral <30 30 - 39 40 - 49 ≥50
valve
Bolded qualitative and semiquantitative signs are considered speci c for their MR grade.
All parameters have limitations, and an integrated approach must be used that weighs the strength of each
echocardiographic measurement. All signs and measures should be interpreted in an individualized manner that
accounts for body size, sex, and all other patient characteristics.
≥4 criteria ≥4 criteria
Definitely mild Definitely severe
3 specific criteria
for severe MR or
elliptical orifice
Variable Abnormal
TrVA* ≤1cm2
Tricuspid valve area (continuity equation)
RA major >50mm
Right atrium major axis dimension
IVCdiameter
>2,1cm
Inferior vena cava diameter
* Speci c ndings
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)
Chronic tricuspid regurgitation
Structural
Usually normal 1
Right atrium (Size) Normal or mild dilatation Usually dilated
(RA major <45mm) (RA major >45mm)
Usually normal 1
Right ventricle (Size) Normal or mild dilatation Usually dilated
(RVD1basal <41mm) (RVD1basal >41mm)
Qualitative doppler
Semiquantitative
RegJetarea (cm2)
Regurgitation jet area Not de ned Not de ned >10
(Nyquist limit 50-70cm/s)
VCW (cm)
Vena contracta width <0,3 0,3 - 0,69 ≥0,7
(Nyquist limit 50-70cm/s)
Quantitative
RegVol (ml)
Regurgitant volume of tricuspid <30 30 - 443 ≥45
regurgitation
Bolded signs are considered speci c for their tricuspid regurgitation grade.
1. RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
2. Signs are nonspeci c and are in uenced by many other factors (RV diastolic function, atrial brillation, RA
pressure).
3. There are little data to support further separation of these values.
2-3 criteria
Specific Criteria for Mild TR Specific Criteria for Severe TR
1. Dilated TV annulus (>35mm) with
1. Thin, small central color jet Minority of criteria or no valve coaptation or flail leaflet
(RegJet/RA area <20%) 2. Large central jet
2. VCW <0,3cm
Intermediate Values:
(RegJet/RA area >50%)
3. PISAr <0,4cm (Nyquist 30-40cm/s) TR Probably Moderate 3. VCW ≥0,7cm
4. Incomplete or faint jet (CW doppler) 4. PISAr >0,9cm (Nyquist 30-40cm/s)
5. Systolic dominant Hepatic vein flow 5. Dense, triangular jet (CW doppler)
6. Tricuspid A-wave dominant inflow Perform VC measurement, and or sine wave pattern
7. Normal RV/RA (RA major <45mm, May perform quantitative PISA 6. Systolic reversal of Hepatic vein flow
RVD1basal <41mm) method, whenever possible. 7. Dilated RV with preserved EF
Clinical experience in quantitation of (RVD1basal >41mm, EF RV >45%)
TR is much less than that with mitral
and aortic regurgitation.
≥4 criteria ≥4 criteria
Pulmonary valve
Pulmonary stenosis
Vmax PV (m/s)
<3 3-4 >4
Maximal (peak) velocity pulmonary valve
maxPG PV (mmHg)
Pulmonary valve maximal pressure <36 36 - 64 >64
gradient
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)
Pulmonary regurgitation
RatioRegJet/PV
Ratio regurgitant jet width / pulmonary valve >70%3
annulus
DTRegJet Short4
Deceleration time of pulmonary regurgitant jet (<260ms)
PHTRegJet <100ms5
Pressure half time of pulmonary regurgitant jet
PAreversal ow Yes
Reversal ow in the branch pulmonary artery
1-2 criteria
Specific Criteria for mild PR Specific Criteria for Severe PR
1. Small Jet (RegJet length <10mm) Minority of criteria or Intermediate 1. Ratio RegJet / PV annulus (>70%)
2. Soft or faint jet (CW doppler) Values: 2. RegJet hart density
3. Slow deceleration time (>260ms) PR Probably Moderate 3. Pressure half time (<100ms)
4. Normal RV size 4. Diastolic flow reversal in PA
(RVD1basal <41mm) branches
5. Dilated RV with NL function
May Perform volumetric (RVD1basal >41mm)
quantitative methods,
if possible, whenever
significant PR is suspected
(Clinical experience in quantitation
of PR is sparse.)
≥2 criteria ≥3 criteria
Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and
the ASE (2015)
Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE
(2018)
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE
(2010)
Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)