Reference (normal) values for echocardiography

Aorta

Normal values for aorta in 2D echocardiography


	Normal interval	Normal interval, adjusted
Aortic annulus	20-31 mm	12-14 mm/m2
Sinus valsalva	29-45 mm	15-20 mm/m2
Sinotubular junction	22-36 mm	13-17 mm/m2
Ascending aorta	22-36 mm	13-17 mm/m2
Aortic arch	22-36 mm
Descending aorta	20-30 mm

Adjustment refers to adjusting for body surface area (BSA).

Aorta, predicted

Aorta, standardized

Standardized values for aorta (mean ± SD)


	Aortic annulus	Sinus valsalva
Age	Women	Men	Women	Men
<30	11.4 ± 1.1	11.4 ± 1.2	15.5 ± 1.5	15.3 ± 1.8
30–39	11.7 ± 1.0	11.4 ± 1.1	16.5 ± 1.6	15.7 ± 1.3*
40–49	11.7 ± 1.0	11.5 ± 0.9	16.8 ± 1.4	16.6 ± 1.5
50–59	12.0 ± 0.9	11.5 ± 0.9	17.9 ± 1.6	16.8 ± 1.7*
60–69	11.7 ± 1.1	12.1 ± 1.0	17.5 ± 1.7	17.8 ± 1.6
>70	11.6 ± 1.1	12.0 ± 1.0	18.2 ± 1.9	18.1 ± 1.7
All	11.7 ± 1.0	11.6 ± 1.0	17.0 ± 1.9	16.6 ± 1.8


	Sinotubular junction	Ascending aorta
Age	Women	Men	Women	Men
<30	13.5 ± 1.4	12.7 ± 2.3	15.1 ± 1.6	14.3 ± 1.6*
30–39	14.3 ± 1.5	13.3 ± 1.3	16.4 ± 1.8	14.5 ± 1.4*
40–49	14.6 ± 1.2	14.1 ± 1.5*	16.4 ± 1.4	15.5 ± 1.5*
50–59	15.7 ± 1.3	14.1 ± 1.5	18.0 ± 1.4	16.2 ± 1.6*
60–69	14.7 ± 1.6	15.1 ± 1.6*	17.6 ± 1.7	17.3 ± 1.7
>70	15.5 ± 2.0	14.7 ± 1.6	18.2 ± 3.3	17.5 ± 1.4
All	14.7 ± 1.7	13.9 ± 1.8	16.9 ± 2.3	15.7 ± 1.8


	Aortic arch
Age	Women	Men
<30	10.7 ± 1.0	10.1 ± 1.3*
30–39	11.6 ± 1.6	10.8 ± 1.3*
40–49	11.5 ± 1.2	11.3 ± 1.3
50–59	12.7 ± 1.1	11.3 ± 1.2*
60–69	12.5 ± 1.4	12.0 ± 1.1
>70	12.7 ± 1.2	12.2 ± 1.3
All	11.9 ± 1.5	11.2 ± 1.4

Aortic valve regurgitation

Aortic valve regurgitation, normal values

Primary parameters


	Mild regurgitation	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 doppler aorta descendens	if present, early diastolic	early diastolic	holodiastolic

Quantification of jet


	Mild regurgitation	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


	Mild regurgitation	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


	Mild regurgitation	Moderate regurgitation	Severe regurgitation
EROA (cm²)	< 0,10	0,10-0,29	> 0,29
Regurgitation volume (ml/beat)	< 30	30-59	> 59
Regurgitation fraction (%)	< 30	30-49	> 49

EROA = (CSA*v)/v(maxMR) {{ Flödeshastighet = CSA*v = 6.28*r2*v(aliasing)

References

1. Zoghbi, William A.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Kraft, Carol D.; Levine, Robert A. et al. (2003): Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 16 (7), pp. 777–802. DOI: 10.1016/S0894-7317(03)00335-3.

2. Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A. et al. (2017): Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 30 (4), pp. 303–371. DOI: 10.1016/j.echo.2017.01.007.

Aortic valve stenosis

Disease defining parameters


	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


	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 / aortic valve)		> 0,5	0,5-0,25	< 0,25

References

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.

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.

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.

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.

Left and right ventricle

Visual assessment of systolic function

Visual assessment of regional wall motion (left ventricle)


TYPE OF MOTION	DEFINITION	WALL MOTION SCORE
Normal	Normal thickening (typically >30% thickening from end-diastole to end-systole).	1
Hypokinesia	Reduced thickening (typically 10–30% thickening from end-diastole to end-systole)	2
Akinesia	Markedly reduced, or no thickening (<10%)	3
Dyskinesia	Paradoxical thinning and/or outward directed motion during systole	4
Aneurysmatic	Diastolic deformation	5

Recommended by American Society for Echocardiography (J Am Soc Echocardiogr 18:1440-1463, 2005).

Left ventricular mass and geometry

Reference values for left ventricular mass and geometry


	Women				Men
	Reference	Mildy abnormal	Moderately abnormal	Severely abnormal	Reference	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/height 2,7 , g/m2,7	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 METOD
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.

Left ventricular dimension and volume

Referensvärden för vänster kammares storlek


	Women				Men
	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal
LV DIMENSIONS
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/m 2	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/m 2	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/m 2	12–30	31–36	37–42	> 43	12–30	31–36	37–42	> 43

BSA, body surface area; LV, left ventricular.

Left ventricular function (ejection fraction)

Reference values for left ventricular function (ejection fraction)


	Women				Men
	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal	Normal	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 METOD
Ejection fraction, %	>55	45–54	30–44	<30	>55	45–54	30–44	<30

2D, Two-dimensional.

Classification of ejection fraction


	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
Ejection fraction (%), biplan, males	52-72	41-51	30-40	<30
Ejection fraction (%), biplan, females	54-74	41-53	30-40	<30

References

1. 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.

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

Diastolic function


Criteria	Normal, young	Normal, adult	Abnormal relaxation (grade 1 dysfunction)	Pseudonormal (grade 2 dysfunction)	Reversible restrictive filling (grade 3 dysfunction)	Irreversible restrictive filling (grade 4 dysfunction)
E/A-ratio	1–2	1–2	<1	1–1.5 (not reversed with Valsalva maneuver)	>1.5	1.5–2.0 (not reversed with Valsalva maneuver)
Deceleration time (DT), ms	<240	150–240	≥240	150–200	<150	<150
IVRT (ms)	70–90	70–90	>90	<90	<70	<70
S/D-ratio	<1	≥1	≥1	<1	<1	<1
ARdur – Adur (ms)	≥30	≤0	≤0 or ≥30	≥30	≥30	≥30
AR speed (cm/s)	<35	<35	<35	≥35	≥35	≥35
e’ speed (cm/s)	>10	>8	<8	<8	<8	<8

Right ventricle & pulmonary artery


	Normal interval	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 DIAMETER
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 SIZE AND FUNCTION (MEASURED IN A4C)
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

Left and right atrium

Reference values for atrial size and volume


	Women				Men
	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal	Normal 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.

Mitral valve

Mitral valve regurgitation

Primary parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Vena contracta (cm)	< 0,3	0,3-0,69	> 0,69
EROA (cm²)	< 0,20	0,20-0,39	> 0,39
Jet size	< 4cm² or < 20% of atrial size	4-10 cm² or 20-40% of atrial size	> 10 cm² or > 40% of atrial size
Jet orientation	central	variable	excentric
Pulmonary vein flow	S-dominant	reduced S-wave	systolic flow reversal,

Qualitative parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Mitral valve apparatus	normal or mildly abnormal	often abnormal	abnormal, possibly flail
CW-profile mitral regurgitation	weak	variable	dense
Shape CW-profile mitral regurgitation	parabolic	variable	early peak, triangular
Size left atrium	normal	normal or dilated	dilated
Size left ventricle	normal	normal or dilated	dilated

Additional PISA-parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Regurgitation volume (ml/beat)	< 30	30-59	> 59
Regurgitation volume = EROA x TVI
Regurgitation fraction (%)	< 30	30-49	> 49

Miscellaneous parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
PW-Doppler mitral valve	A dominant	variable	high E values

References

Mitral valve stenosis

Primary parameters


	Mild stenosis	Moderate stenosis	Severe stenosis
Valve area	> 1,5 cm²	1,5 – 1,0 cm²	< 1,0 cm²
Mean gradient	< 5 mmHg	5-10 mmHg	> 10 mmHg

Additional parameters


	Mild stenosis	Moderate stenosis	Severe stenosis
Pulmonary artery pressure	<30	30-50	>50

References

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 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.

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 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.

Tricuspid valve

Tricuspid valve regurgitation

Primary parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
PISA radius	< 0,6	0,6-0,9	> 0,9
Vena contracta (cm)	not defined	< 0,7	> 0,7
Liver vein flow	S-dominant	Reduced S-wave	systolic flow reversal, jet reaching liver veins

Additional quantitative parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Jet size	< 5cm²	5-10 cm²	> 10 cm²
size vena cava inferior	< 2,1 cm and compressible	in between	> 2,1 cm, almost not compressible

Additional qualitative parameters


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Coaptation defect	mild	moderate	severe
Size right ventricle	normal	normal or enlarged	enlarged
Size right atrium	normal	normal or enlarged	enlarged
CW-profile tricuspid regurgitation	weak	variable	dense
Shape CW-profile tricuspid regurgitation	parabolic	variable	early peak, triangular

References

Tricuspid valve stenosis


Mean pressure gradient	≥ 5 mmHg
Valve area according to the continuity equation (cm²)	≤ 1 cm²
ZTime-velocity-integral of the tricuspid inflow (cm)	> 60 cm
Pressure half time (T ½,ms)	≥ 190 ms
Right atrium	Severly enlarged
Vena cava inferior	enlarged

References

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 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.

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 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

Pulmonary valve

Pulmonary valve regurgitation


	Mild regurgiation	Moderate regurgitation	Severe regurgitation
Pulmonary valve morphology	normal	normal/abnormal	abnormal
Density CW-Doppler	weak, slow deceleration	variable	dense, steep deceleration, early termination of diastolic flow
Jet width colour Doppler	small,, < 10 mm length, narrow origin	variable	large, wide origin
Ratio pulmonic to aortic flow	normal	variable	significantly increased

References

3. Lancellotti, Patrizio; Tribouilloy, Christophe; Hagendorff, Andreas; Moura, Luis; Popescu, Bogdan A.; Agricola, Eustachio et al. (2010): European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 11 (3), pp. 223–244. DOI: 10.1093/ejechocard/jeq030.

Pulmonary valve stenosis


	Mild stenosis	Moderate stenosis	Severe stenosis
Peak velocity (m/s)	< 3	43528	> 4
Peak gradient (mmHg)	< 36	36-64	> 64

References

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 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.

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 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

Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left ventricle is divided into 17 segments for 2D echocardiography. One can identify these segments in multiple views. Figure 2. Display, on a circumferential polar plot, of the 17 myocardial segments and the recommended nomenclature for tomographic imaging of the heart. Figure 3. Assignment of the 17 myocardial segments to the territories of the left anterior descending (LAD), right coronary artery (RCA), and the left circumflex coronary artery (LCX).

Reference (normal) values for echocardiography

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