0
edits
Normal Values: Difference between revisions
m
no edit summary
mNo edit summary |
|||
| Line 575: | Line 575: | ||
|} | |} | ||
==Aortic regurgitation - severity== | |||
= | |||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+''' | |+'''Application of specific and supportive signs, and quantitative parameters in the grading of aortic regurgitation severity<cite>ASERE</cite>''' | ||
|- | |- | ||
! | ! style="width:160px" | | ||
! | ! style="width:250px" | Mild | ||
! | ! colspan="2" | Moderate | ||
! style="width:250px" | Severe | |||
|- | |- | ||
! | ! Specific signs for AR severity | ||
| style="vertical-align:top" | <ul> | |||
<li>Central Jet, width < 25% of LVOT<sup>ς</sup></li> | |||
<li>Vena contracta < 0.3 cm<sup>ς</sup></li> | |||
<li>No or brief early diastolic flow reversal in descending aorta</li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Signs of AR>mild present but no criteria for severe AR</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Central Jet, width ≥ 65% of LVOT<sup>ς</sup></li> | |||
<li>Vena contracta > 0.6cm<sup>ς</sup></li> | |||
</ul> | |||
|- | |- | ||
| style="vertical-align:top | ! Supportive signs | ||
| style="vertical-align:top | | style="vertical-align:top" | <ul> | ||
<li>Pressure half-time > 500 ms</li> | |||
<li>Normal LV size<sup>∗</sup></li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate values</li></ul> | |||
| <ul> | |||
<li>Pressure half-time < 200 ms</li> | |||
<li>Holodiastolic aortic flow reversal in descending aorta</li> | |||
<li>Moderate or greater LV enlargement<sup>∗∗</sup></li> | |||
</ul> | |||
|- | |- | ||
| | | colspan="5" | '''Quantitative parameters<sup>ψ</sup>''' | ||
|- | |- | ||
| style=" | | style="padding-left:12px" | R Vol, ml/beat | ||
| style=" | | align="center" | < 30 | ||
| align="center" style="width:125px" | 30-44 | |||
| align="center" style="width:125px" | 45-59 | |||
| align="center" | ≥ 60 | |||
|- | |- | ||
| style=" | | style="padding-left:12px" | RF % | ||
| | | align="center" | < 30 | ||
| align="center" | 30-39 | |||
| align="center" | 40-49 | |||
| align="center" | ≥ 50 | |||
|- | |- | ||
| style="padding-left:12px" | EROA, cm<sup>2</sup> | |||
| align="center" | < 0.10 | |||
| align="center" | 0.10-0.19 | |||
| align="center" | 0.20-0.29 | |||
| align="center" | ≥ 0.30 | |||
|- | |- | ||
| | | colspan="5" | | ||
<ul> | |||
<li><em>AR</em>, Aortic regurgitation; <em>EROA</em>, effective regurgitant orifice area; <em>LV</em>, left ventricle; <em>LVOT</em>, left ventricular outflow tract; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li> | |||
<li><sup>∗</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor-axis ≤ 2.8 cm/m<sup>2</sup>, LV end-diastolic volume ≤ 82 ml/m<sup>2</sup> (2).</li> | |||
<li><sup>ς</sup> At a Nyquist limit of 50–60 cm/s.</li> | |||
<li><sup>∗∗</sup> In the absence of other etiologies of LV dilatation.</li> | |||
<li><sup>ψ</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.</li> | |||
</ul> | |||
|} | |||
=Mitral Valve= | |||
| | ==Mitral regurgitation - severity== | ||
{| class="wikitable" style="font-size:90%;" | |||
| | |+'''Application of specific and supportive signs, and quantitative parameters in the grading of mitral regurgitation severity<cite>ASERE</cite>''' | ||
|- | |- | ||
| style=" | ! style="width:160px" | | ||
| style=" | ! style="width:250px" | Mild | ||
! colspan="2" | Moderate | |||
! style="width:250px" | Severe | |||
|- | |- | ||
| style="vertical-align:top" | - | ! Specific signs of severity | ||
| style="vertical-align:top" | - | | style="vertical-align:top" | <ul> | ||
<li>Small central jet <4 cm<sup>2</sup> or <20% of LA area<sup>ψ</sup></li> | |||
<li>Vena contracta width <0.3 cm</li> | |||
<li>No or minimal flow convergence</li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Signs of MR>mild present, but no criteria for severe MR</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Vena contracta width ≥ 0.7cm <em>with</em> large central MR jet (area < 40% of LA) or with a wall-impinging jet of any size, swirling in LA<sup>ψ</sup></li> | |||
<li>Large flow convergence<sup>ς</sup></li> | |||
<li>Systolic reversal in pulmonary veins</li> | |||
<li>Prominent flail MV leaflet or ruptured papillary muscle</li> | |||
</ul> | |||
|- | |- | ||
! | ! Supportive signs | ||
| style="vertical-align:top" | <ul> | |||
<li>Systolic dominant flow in pulmonary veins</li> | |||
<li>A-wave dominant mitral inflow<sup>Φ</sup></li> | |||
<li>Soft density, parabolic CW Doppler MR signal</li> | |||
<li>Normal LV size<sup>∗</sup></li> | |||
</ul> | |||
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate signs/findings</li></ul> | |||
| style="vertical-align:top" | <ul> | |||
<li>Dense, triangular CW Doppler MR jet</li> | |||
<li>E-wave dominant mitral inflow (E >1.2 m/s)<sup>Φ</sup> Enlarged LV and LA size<sup>∗∗</sup>, (particularly when normal LV function is present).</li> | |||
</ul> | |||
|- | |- | ||
| | | colspan="5" | '''Quantitative parameters<sup>φ</sup>''' | ||
|- | |- | ||
| style=" | | style="padding-left:12px" | R Vol (ml/beat) | ||
| align="center" | < 30 | |||
- | | style="width:125px" align="center" | 30-44 | ||
- | | style="width:125px" align="center" | 45-59 | ||
| align="center" | ≥ 60 | |||
|- | |- | ||
| | | style="padding-left:12px" | RF (%) | ||
| align="center" | < 30 | |||
| align="center" | 30-39 | |||
| align="center" | 40-49 | |||
| align="center" | ≥ 50 | |||
|- | |- | ||
| style=" | | style="padding-left:12px" | EROA (cm<sup>2</sup>) | ||
| align="center" | < 0.20 | |||
| align="center" | 0.20-0.29 | |||
| align="center" | 0.30-0.39 | |||
| align="center" | ≥ 0.40 | |||
| | |||
| | |||
|- | |- | ||
| | | colspan="5" | <ul> | ||
<li><em>CW</em>, Continuous wave; <em>EROA</em>, effective regurgitant orifice area; <em>LA</em>, left atrium; <em>LV</em>, left ventricle; <em>MV</em>, mitral valve; <em>MR</em>, mitral regurgitation; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li> | |||
<li><sup>∗</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor axis ≤ 2.8 cm/m<sup>2</sup>, LV end-diastolic volume ≤ 82 ml/m<sup>2</sup>, maximal LA antero-posterior diameter ≤ 2.8 cm/m<sup>2</sup>, maximal LA volume ≤ 36 ml/m<sup>2</sup> (2;33;35).</li> | |||
<li><sup>∗∗</sup> In the absence of other etiologies of LV and LA dilatation and acute MR.</li> | |||
<li><sup>ψ</sup> At a Nyquist limit of 50-60 cm/s.</li> | |||
<li><sup>Φ</sup> Usually above 50 years of age or in conditions of impaired relaxation, in the absence of mitral stenosis or other causes of elevated LA pressure.</li> | |||
<li><sup>ς</sup> Minimal and large flow convergence defined as a flow convergence radius < 0.4 cm and ≤ 0.9 cm for central jets, respectively, with a baseline shift at a Nyquist of 40 cm/s; Cut-offs for eccentric jets are higher, and should be angle corrected (see text).</li> | |||
<li><sup>φ</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe as shown.</li> | |||
</ul> | |||
|} | |} | ||
==Mitral stenosis - severity== | ==Mitral stenosis - severity== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
| Line 750: | Line 809: | ||
|} | |} | ||
= | ==Mitral stenosis - routine measurements== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+''' | |+'''Recommendations for data recording and measurement in routine use for mitral stenosis quantitation<cite>ASEVS</cite>''' | ||
|- | |- | ||
! Data element | |||
! Recording | |||
! Measurement | |||
|- | |- | ||
! rowspan="5" | Planimetry | |||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - 2D parasternal short-axis view | ||
| | | style="vertical-align:top; " | - contour of the inner mitral orifice | ||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - determine the smallest orifice by scanning from apex to base | ||
| | | style="vertical-align:top; " | - include commissures when opened | ||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - positioning of measurement plan can be oriented by 3D echo | ||
| | | style="vertical-align:top; " | - in mid-diastole (use cine-loop) | ||
|- | |||
| style="vertical-align:top" | - lowest gain setting to visualize the whole mitral orifice | |||
| style="vertical-align:top" | - average measurements if atrial fibrillation | |||
|- | |- | ||
! rowspan="4" | Mitral flow | |||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - continuous-wave Doppler | ||
| | | style="vertical-align:top; " | - mean gradient from the traced contour of the diastolic mitral flow | ||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - apical windows often suitable (optimize intercept angle) | ||
| | | style="vertical-align:top; " | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear) | ||
|- | |- | ||
| | | style="vertical-align:top" | - adjust gain setting to obtain well-defined flow contour | ||
| style="vertical-align:top" | - average measurements if atrial fibrillation | |||
| | |||
|- | |- | ||
! | ! rowspan="3" | Systolic pulmonary artery pressure | ||
|- | |- | ||
| | | style="vertical-align:top; " | - continuous-wave Doppler | ||
| style="vertical-align:top; " | - maximum velocity of tricuspid regurgitant flow | |||
| | |||
|- | |- | ||
| | | style="vertical-align:top" | - multiple acoustic windows to optimize intercept angle | ||
| style="vertical-align:top" | - estimation of right atrial pressure according to inferior vena cava diameter | |||
| | |||
|- | |- | ||
! | ! rowspan="8" | Valve anatomy | ||
|- | |- | ||
| rowspan="2" style="vertical-align:top; " | | |||
| | - parasternal short-axis view | ||
|- | |- | ||
| style="vertical-align:top; " | | |||
| style="vertical-align:top" | | - valve thickness (maximum and heterogeneity)<br> | ||
- commissural fusion<br> | |||
- extension and location of localized bright zones (fibrous nodutes or calcification) | |||
|- | |- | ||
| | | rowspan="2" style="vertical-align:top; " | | ||
- parasternal long-axis view | |||
|- | |- | ||
| style=" | | style="vertical-align:top; " | | ||
- valve thickness<br> | |||
- extension of calcification<br> | |||
- valve pliability<br> | |||
- subvalvular apparatus (chordal thickening, fusion, or shortening) | |||
|- | |- | ||
| | | rowspan="2" style="vertical-align:top" | - apical two-chamber view | ||
|- | |- | ||
| style=" | | style="vertical-align:top; " | - subvalvular apparatus (chordal thickening, fusion, or shortening)<br> | ||
|- | |- | ||
| colspan=" | | colspan="2"| | ||
Detail each component and summarize in a score | |||
|} | |} | ||
=Tricuspid Valve= | |||
==Tricuspid regurgitation - severity== | |||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+'''Echocardiographic and Doppler parameters used in grading tricuspid regurgitation severity''' | |+'''Echocardiographic and Doppler parameters used in grading tricuspid regurgitation severity<cite>ASERE</cite>''' | ||
|- | |- | ||
| Line 1,037: | Line 967: | ||
|} | |} | ||
== | ==Tricuspid stenosis - severity== | ||
{| class="wikitable" style="font-size:90%;" | {| class="wikitable" style="font-size:90%;" | ||
|+'''Echocardiographic and Doppler parameters used in grading pulmonary regurgitation severity''' | |+'''Findings indicative of haemodynamically significant tricuspid stenosis<cite>ASEVS</cite>''' | ||
|- | |||
| colspan="2" | '''Specific findings''' | |||
|- | |||
| style="width:190px; padding-left:12px" | Mean pressure gradient | |||
| style="width:80px" | ≥5 mmHg | |||
|- | |||
| style="padding-left:12px" | Inflow time-velocity integral | |||
| >60 cm | |||
|- | |||
| style="padding-left:12px" | <em>T</em><sub>1/2</sub> | |||
| ≥190 ms | |||
|- | |||
| style="padding-left:12px" | Valve area by continuity equation<sup>a</sup> | |||
| ≤1 cm<sup>2</sup> | |||
|- | |||
| colspan="2" | '''Supportive findings''' | |||
|- | |||
| style="padding-left:12px" | Enlarged right atrium ≥moderate | |||
| | |||
|- | |||
| style="padding-left:12px" | DHated inferior vena cava | |||
| | |||
|- | |||
| colspan="2" | <ul> | |||
<li><sup>a</sup>Stroke 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 cm<sup>2</sup> implies a significant haemodynamic burden imposed by the combined lesion. | |||
</li> | |||
</ul> | |||
|} | |||
=Pulmonary Valve= | |||
==Pulmonary regurgitaion - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Echocardiographic and Doppler parameters used in grading pulmonary regurgitation severity<cite>ASERE</cite>''' | |||
|- | |- | ||
| Line 1,090: | Line 1,063: | ||
|} | |} | ||
==Pulmonary stenosis - severity== | |||
{| class="wikitable" style="font-size:90%;" | |||
|+'''Grading of pulmonary stenosis<cite>ASEVS</cite>''' | |||
|- | |||
! style="width:150px" | | |||
! style="width:80px" | Mild | |||
! style="width:80px" | Moderate | |||
! style="width:80px" | Severe | |||
|- | |||
| Peak velocity (m/s) | |||
| align="center" | <3 | |||
| align="center" | 3-4 | |||
| align="center" | >4 | |||
|- | |||
| Peak gradient (mmHg) | |||
| align="center" | <36 | |||
| align="center" | 36-64 | |||
| align="center" | >64 | |||
|} | |||
=References= | =References= | ||