Echocardia - Normal values

Aorta

for both genders

Size of aortic annulus
▶

Used view: standard parasternal long axis

20-31 mm; normalized for body surface area: 12-14 mm/m²
Sinus Valsalva
▶

Used view: standard parasternal long axis

29-45 mm; normalized for body surface area: 15-20 mm/m²
Sinutubular junction
▶

Used view: standard parasternal long axis

22-36mm; normalized for body surface area: 13-17 mm/m²
Aorta ascendens
▶

Used view: standard parasternal long axis

22-36mm; normalized for body surface area: 13-17 mm/m²
Aortic arch
▶

Used view: suprasternal, aortic arch

22-36 mm

Reference values adapted from

1. Evangelista, Arturo; Flachskampf, Frank A.; Erbel, Raimund; Antonini-Canterin, Francesco; Vlachopoulos, Charalambos; Rocchi, Guido et al. (2010): Echocardiography in aortic diseases: EAE recommendations for clinical practice. In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 11 (8), pp. 645–658. DOI: 10.1093/ejechocard/jeq056. –>Pubmed-Link
2. Hiratzka, L. F. et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121, e266–e369 (2010). –>Pubmed-Link
3. Armstrong, W., Ryan, T. & Feigenbaum, H. Feigenbaum’s echocardiography. (Lippincott Williams & Wilkins, 2010).
4. Roman, M. J., Devereux, R. B., Kramer-Fox, R. & O’Loughlin, J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am. J. Cardiol. 64, 507–512 (1989). –> Pubmed-Link
5. Erbel, R.; Alfonso, F.; Boileau, C.; Dirsch, O.; Eber, B.; Haverich, A. et al. (2001): Diagnosis and management of aortic dissection. In European heart journal 22 (18), pp. 1642–1681. DOI: 10.1053/euhj.2001.2782. –>Pubmed-Link

Aortic valve regurgitation

for both genders

Most important parameters
▶

Parameter	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Vena contracta (cm)	< 0,3	0,3-0,6	> 0,6
PHT (pressure half time) CW-Doppler	> 500	200-500	< 200
Diastolic flow reversal PW aorta descendens	if present, early diastolic	early diastolic	holodiastolic

Jet-quantification
▶

Parameter	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Jet-width / LVOT-width	< 0,25	0,25-0,64	> 0,64
Jet-area / LVOT-area	< 0,05	0,05-0,59	> 0,59

Qualitative parameters
▶

Parameter	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Jet area	small	variable	large if central, variable if excentric
Coaptation defect	mild	moderate	severe
CW-profile aortic regurgitation	weak	variable	dense
Size left atrium	normal	normal or enlarged	enlarged
Size left ventricle	normal	normal or enlarged	enlarged

Additional PISA-parameters
▶

Parameter	Mild regurgiation	Moderate regurgitation	Severe regurgitation
EROA (cm²) EROA = Cross sectional area x velocity / max. MR-velocity. Flow rate = Cross sectional area x velocity = 6,28 x r2 x Aliasing velocity	< 0,10	0,10-0,29	> 0,29
Regurgitation volume (ml/beat) Regurgitation volume = EROA x TVI	< 30	30-59	> 59
Regurgitation fraction (%)	< 30	30-49	> 49

Reference values adapted from

Aortic valve stenosis

for both genders

Disease defining parameters
▶

Parameter	Mild stenosis	Moderate stenosis	Severe stenosis
Valve area (cm²)	> 1,5	1,0-1,5	< 1,0
Normalized valve area (cm²/m²)	>0,85	0,6-0,85	< 0,6

Measured parameters
▶

Parameter	Aortic sclerosis	Mild stenosis	Moderate stenosis	Severe stenosis
Mean gradient (mmHg)		< 20	20-40	> 40
Peak velocity (m/s)	1,8-2,5	2,6-2,9	3,0-4,0	> 4,0
Peak gradient (mmHg)		< 35	35-65	> 65
Velocity ratio (LVOT / aotric valve)		> 0,5	0,5-0,25	< 0,25

Reference values adapted from

1. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P. et al. (2009): Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 22 (1), 1-23; quiz 101-2. DOI: 10.1016/j.echo.2008.11.029. –>Pubmed-Link
2. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P. et al. (2009): Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 10 (1), pp. 1–25. DOI: 10.1093/ejechocard/jen303. –>Pubmed-Link
3. Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita; Antunes, Manuel J.; Barón-Esquivias, Gonzalo; Baumgartner, Helmut et al. (2012): Guidelines on the management of valvular heart disease (version 2012). In European heart journal 33 (19), pp. 2451–2496. DOI: 10.1093/eurheartj/ehs109. –>Pubmed-Link
4. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Edvardsen, Thor; Goldstein, Steven et al. (2017): Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis. A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 30 (4), pp. 372–392. DOI: 10.1016/j.echo.2017.02.009. –>Pubmed-Link

Atria

for both genders

Left atrium
▶

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Left atrial diameter (cm)	3,0-4,0	4,1-4,6	4,7-5,2	> 5,2
Left atrial diameter/body surface (cm/m²)	1,5-2,3	2,4-2,6	2,7-2,9	> 2,9
Left atrial area (cm²)	< 21	21-30	31-40	> 40
Left atrial volume/body surface (ml/m²)	≤ 34

Right atrium
▶

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Minor right atrial diameter (cm)	2,9-4,5	4,6-4,9	5,0-5,4	> 5,4
Minor right atrial diameter/body surface (cm/m²)	1,9 ± 0,3 (1 SD)
Major right atrial diameter/body surface (cm/m²), Females	2,5 ± 0,3 (1 SD)
Major right atrial diameter/body surface (cm/m²), Males	2,4 ± 0,3 (1 SD)
Right atrial volume/body surface (ml/m²), Females	21 ± 6 (1 SD)
Right atrial volume/body surface (ml/m²), Males	25 ± 7 (1 SD)

Reference values adapted from

1.Lang, Roberto M.; Bierig, Michelle; Devereux, Richard B.; Flachskampf, Frank A.; Foster, Elyse; Pellikka, Patricia A. et al. (2006): Recommendations for chamber quantification. In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 7 (2), pp. 79–108. DOI: 10.1016/j.euje.2005.12.014. –>Pubmed-Link
2. Lang, Roberto M.; Bierig, Michelle; Devereux, Richard B.; Flachskampf, Frank A.; Foster, Elyse; Pellikka, Patricia A. et al. (2005): Recommendations for chamber quantification: a report from the American Society of Echocardiography's 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. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 18 (12), pp. 1440–1463. DOI: 10.1016/j.echo.2005.10.005. –>Pubmed-Link
3. Lang, Roberto M.; Badano, Luigi P.; Mor-Avi, Victor; Afilalo, Jonathan; Armstrong, Anderson; Ernande, Laura et al. (2015): Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 28 (1), 1-39.e14. DOI: 10.1016/j.echo.2014.10.003. –>Pubmed-Link
4. Lang, Roberto M.; Badano, Luigi P.; Mor-Avi, Victor; Afilalo, Jonathan; Armstrong, Anderson; Ernande, Laura et al. (2015): Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal cardiovascular Imaging 16 (3), pp. 233–270. DOI: 10.1093/ehjci/jev014. –>Pubmed-Link

Left ventricle

Ejection fraction
▶

Classic classification - for both genders

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ejection fraction (%) biplane	≥55	45-54	30-44	<30

Parameter

Normal

Mildly abnormal

Moderately abnormal

Severely abnormal

Ejection fraction (%)

biplane

≥55

45-54

30-44

<30

New classification

Males

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ejection fraction (%) biplane	52-72	41-51	30-40	<30

Parameter

Normal

Mildly abnormal

Moderately abnormal

Severely abnormal

Ejection fraction (%)

biplane

52-72

41-51

30-40

<30

Females

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ejection fraction (%) biplane	54-74	41-53	30-40	<30

Parameter

Normal

Mildly abnormal

Moderately abnormal

Severely abnormal

Ejection fraction (%)

biplane

54-74

41-53

30-40

<30

Female reference values left ventricle
▶

Walls and mass

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Wall thickness (cm) - posterior and septal	0,6-0,9	1,0-1,2	1,3-1,5	> 1,5
Left ventricular mass/body surface (g/m²) - linear method Devereux formula: LV mass = 0,8 x 1,04 x [(IVSD+LVEDD+PWTD)³-LVEDD³]+0,6 IVSD = Interventricular septal wall thickness in diastole, LVEDD = Leftventricular enddiastolic diameter, PWTD = Posterior wall thickness in enddiastole	43-95	96-108	109-121	> 121
Left ventricular mass/body surface (g/m²) - 2D method 2D methods: truncated ellipsoid method or area length method	44-88	89-100	101-112	> 112
Relative wall thickness (cm)* = 2 x posterior wall / left ventricular diastolic diameter	0,22-0,42	0,43-0,47	0,48-0,52	>0,52

Diameter and volumina

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ventricular diastolic diameter (cm)	3,8-5,2	5,3-5,6	5,7-6,1	> 6,1
Ventricular diastolic diameter/body surface (cm/m²)	2,3-3,1	3,2-3,4	3,5-3,7	> 3,7
Left ventricular diastolic volume (ml)	46-106
Left ventricular diastolic volume/body surface (ml/m²)	29-61	62-70	71-80	> 80
Left ventricular systolic volume (ml)	14-42
Left ventricular systolic volume/body surface (ml/m²)	8-24

Additional left ventricular funtional parameter

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Linear Method
Endocardial fractional shortening (%) *	27-45
Midwall fractional shortening (%) *	15-23

* according to 2005/06 guidelines, no longer listed in 2015

Male reference values left ventricle
▶

Walls and mass

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Wall thickness (cm) - posterior and septal	0,6-1,0	1,1-1,3	1,4-1,6	> 1,6
Left ventricular mass/body surface (g/m²) - linear method Devereux formula: LV mass = 0,8 x 1,04 x [(IVSD+LVEDD+PWTD)³-LVEDD³]+0,6 IVSD = Interventricular septal wall thickness at enddiastole, LVEDD = Leftventricular enddiastolic diameter, PWTD = Posterior wall thickness at enddiastole	49-115	116-131	132-148	> 148
Left ventricular mass/body surface (g/m²) - 2D method 2D methods: truncated ellipsoid method or area length method	50-102	103-116	117-130	> 130
Relative wall thickness (cm)* = 2 x posterior wall / left ventricular diastolic diameter	0,24-0,42	0,43-0,46	0,47-0,51	> 0,51

Diameter and volumina

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ventricular diastolic diameter (cm)	4,2-5,8	5,9-6,3	6,4-6,8	> 6,8
Ventricular diastolic diameter/body surface (cm/m²)	2,2-3,0	31,-3,3	3,4-3,6	> 3,6
Left ventricular diastolic volume (ml)	62-150
Left ventricular diastolic volume / body surface area (ml/m² )	34-74	75-89	90-100	> 100
Left ventricular systolic volume (ml)	21-61
Left ventricular systolic volume/body surface (ml/m²)	11-31

Additional left ventricular funtional parameters

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Linear Method
Endokardial fractional shortening * (%)	25-43
Midwall fractional shortening (%) *	14-22

* according to 2005/06 guidelines, no longer listed in 2015

LV geometry
▶

Normal geometry:
relative wall thickness < 0,42 + lv mass < 95 g/m² (w) or < 115 g/m² (m)
Concentric remodelling:
relative wall thickness > 0,42 + lv mass < 95 g/m² (w) or < 115 g/m² (m)
Concentric hypertrophy
relative wall thickness > 0,42 + lv mass > 95 g/m² (w) or > 115 g/m² (m)
excentric hypertrophy:
relative wall thickness < 0,42 + lv mass > 95 g/m² (w) or > 115 g/m² (m)

Reference values adapted from