Normal Values

Left Ventricular Mass and Geometry

Reference limits and partition values of left ventricular mass and geometry[1]

	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
BSA, Body surface area; LV, left ventricular; 2D, 2-dimensional. Green values: Recommended and best validated.

Left Ventricular Size

Reference limits and partition values of left ventricular size[1]

	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
BSA, body surface area; LV, left ventricular. Green values: Recommended and best validated.

Left Ventricular Function

Reference limits and values and partition values of left ventricular function[1]

	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
2D, Two-dimensional. Green values: Recommended and best validated.

Right Ventricular and Pulmonary Artery Size

Reference limits and partition values of right ventricular and pulmonary artery size[1]

	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
RV, Right ventricular; RVOT, right ventricular outflow tract; PA, pulmonary artery. Data from Foale et al.[2]

Right Ventricular Size and Function

Reference limits and partition values of right ventricular size and function as measured in the apical 4-chamber view[1]

	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
RV, Right ventricular. Data from Weyman.[3]

Left Atrial Dimensions / Volumes

Reference limits and partition values for left atrial dimensions/volumes[1]

	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
BSA, Body surface area; LA, left atrial; RA, right atrial. Green values: Recommended and best validated.

Aortic valve stenosis - severity

Recommendations for classification of AS 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
aESC Guidelines. bAHA/ACC Guidelines.

Mitral valve stenosis - Wilkins score

Assessment of mitral valve anatomy according to the Wilkins score⁶⁴

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
The total score is the sum of the four items and ranges between 4 and 16.

Mitral stenosis - routine measurements

Recommendations for data recording and measurement in routine use for mitral stenosis quantitation

Data element	Recording	Measurement
Planimetry	2D parasternal short-axis view determine the smallest orifice by scanning from apex to base positioning of measurement plan can be oriented by 3D echo lowest gain setting to visualize the whole mitral orifice	contour of the inner mitral orifice include commissures when opened in mid-diastole (use cine-loop) average measurements if atrial fibrillation
Mitral flow	continuous-wave Doppler apical windows often suitable (optimize intercept angle) adjust gain setting to obtain well-defined flow contour	mean gradient from the traced contour of the diastolic mitral flow pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear) average measurements if atrial fibrillation
Systolic pulmonary artery pressure	continuous-wave Doppler multiple acoustic windows to optimize intercept angle	maximum velocity of tricuspid regurgitant flow estimation of right atrial pressure according to inferior vena cava diameter
Valve anatomy	parasternal short-axis view parasternal long-axis view apical two-chamber view	valve thickness (maximum and heterogeneity) commissural fusion extension and location of localized bright zones (fibrous nodutes or calcification) valve thickness extension of calcification valve pliability subvalvular apparatus (chordal thickening, fusion, or shortening) subvalvular apparatus (chordal thickening, fusion, or shortening) Detail each component and summarize in a score

Mitral stenosis - severity

Recommendations for classification of 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
aAt heart rates between 60 and 80 bpm and in sinus rhythm.

Tricuspid stenosis - severity

Findings indicative of haemodynamically significant tricuspid stenosis

Specific findings
Mean pressure gradient	≥5 mmHg
Inflow time-velocity integral	>60 cm
T1/2	≥190 ms
Valve area by continuity equationa	≤1 cm2a
Supportive findings
Enlarged right atrium ≥moderate
DHated inferior vena cava
aStroke 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 cm2 implies a significant haemodynamic burden imposed by the combined lesion.

VS Guideline - Table 11

Grading of pulmonary stenosis

	Mild	Moderate	Severe
Peak velocity (m/s)	<3	3-4	>4
Peak gradient (mmHg)	<36	36-64	>64

References

<biblio>

1. Foale pmid=3730205
2. Weyman isbn=0812112075
3. ASE pmid=16458610

</bilbio>