LV dimensions

LV size

LV mass

LV geometry

LV systolic function

LV function

LV ejection fraction

LV strain

LV diastolic function

LV dimensions

Each echocardiogram include an assessment of LV dimensions, describing wall thickness and function. Good measurements are essential and may have implications for therapy. LV dimensions must be measured in PLAX, end-diastolic and end-systolic and valves (MV and AOV) are closed. The measurement is situated in the basal part of the LV by the chordae.

LV size

Parameter	Men		Women
	Mean ± SD	2-SD range	Mean ± SD	2-SD range
LVED diameter (mm)	50.2 ± 4.1	42.0 - 58.4	45.0 ± 3.6	37.8 - 52.2
LVESD diameter (mm)	32.4 ± 3.7	25.0 - 39.8	28.2 ± 3.3	21.6 - 34.8
LVED Volume (biplane, mL)	106 ± 22	62 - 150	76 ± 15	46 - 106
LVES Volume (biplane, mL)	41 ± 10	21 - 61	28 ± 7	14 - 42
LVED Volume (BSA index, mL/m²)	54 ± 10	34 - 74	45 ± 8	29 - 61
LVES Volume (BSA index, mL/m²)	21 ± 5	11 - 31	16 ± 4	8 - 24

LV Mass

Parameter	Men	Women
LV mass (g)	88 - 224	67 - 162
LV mass/BSA (g/m²)	49 - 115	43 - 95
Relative Wall thickness (mm)	24 - 42	22 - 42
Septal thickness (mm)	6 - 10	6 - 9
Posterior thickness (mm)	6 - 10	6 - 9

LV geometry

	Relative wall thickness	Left ventricular mass index
		Women	Men
Normal geometry	≤0.42	≤95	≤115
Concentric remodeling	>0.42	≤95	≤115
Concentric hypertrophy	>0.42	>95	>115
Eccentric hypertrophy	≤0.42	>95	>115

Relative wall thickness and left ventricular mass estimated by LV cavity dimension and wall thickness at end-diastole. Click here for calculation.

LV systolic function

Each echocardiogram include an assessment of LV dimensions, describing wall thickness and function. It is essential to make multiple measurements for a proper assessment of LV function.

LV function

Parameter	Men				Women
	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal
Linear method
Wallmotion score index	1.0	1.0-1.5	1.5-2.0	<2.0	1.0	1.0-1.5	1.5-2.0	<2.0
Endocardial fractional shortening, %	25-43	20-24	15-19	≤14	27-45	22-26	17-21	≤16
Midwall fractional shortening, %	14-22	12-13	10-11	≤10	15-23	13-14	11-12	≤10
Doppler Method
Myocard performance index	<0.40				<0.40
dP/dt	>1100			<500	>1100			<500

LV Ejection fraction

Parameter	Normal	Mildly abnormal	Moderately abnormal	Severely abnormal
LVEF (%) Men	72 – 52	51 – 41	40 – 30	<30
LVEF (%) Women	74 – 54	53 – 41	40 – 30	<30

Eyeballing LVEF

Cardiac ejection fraction (EF) eyeballing may be the most accurate echocardiographic method for the assessment of left ventricular systolic function. Test yourself and learn by doing with this QUIZ.

LV Strain

Parameter	All Levels	Apical	Mid	Basal	pValue (Levels)
All Walls	-18.6±5.1	-20.2±5.6	-18.7±3.3	-17.0±5.2	<0.0001
Anterior	-19.5±4.2	-19.4±5.4	-18.8±3.4	-20.1±4.0	0.001
Anteroseptal	-18.8±4.2	-18.8±5.9	-19.4±3.2	-18.3±3.5	0.001
Inferior	-20.0±4.5*	-22.5±4.5	-20.4±3.5	-17.1±3.9	<0.0001
Lateral	-18.3±4.7	-19.2±5.4	-18.1±3.5	-17.3±5.0	0.06
Posterior	-16.3±6.3	-17.7±6.0	-16.8±5.0	-14.5±7.4	<0.0001
Septal	-18.3±5.3	-22.3±4.8	-18.7±3.0	-13.7±4.0	<0.0001
p (walls)	<0.0001	<0.0001	<0.0001	<0.0001
*inferior was significantly different from other walls (p<0.001 except anterior p+0.002), in the comparison of walls at all levels.Posterior was significantly different from all other walls (p<0.0001). In the comparison oflevels in all walls, each level was significantly different (p <0.0001). LV=left ventricular, TQ=tracking quality.

LV diastolic function

Still a lot remains unclear about the pathophysiology of diastolic heart failure, which still lacks an effective treatment, with a high mortality rate associated with diastolic heart failure over the last decades. Diastolic heart failure is characterized by an increased LV diastolic stiffness. There are some important echocardiographic measurements that should be included in the standard ultrasound examination in order to a properly assessment of the LV stiffness.

LV diastolic function

Measurement	Age group 16-20 (y)	Age group 21-40 (y)	Age group 41-60 (y)	Age group >60 (y)
IVRT (ms)	50 ± 9 (32-68)	67 ± 8 (51-83)	74 ± 7 (60-88)	87 ± 7 (73-101)
E/A ratio	1.88 ± 0.45 (0.98-2.78)	1.53 ± 0.40 (0.73-2.33)	1.28 ± 0.25 (0.78-1.78)	0.96 ± 0.18 (0.6-1.32)
DT (ms)	142 ± 19 (104-180)	166 ± 14 (138-194)	181 ± 19 (143-219)	200 ± 29 (142-258)
A duration (ms)	113 ± 17 (79-147)	127 ± 13 (101-153)	133 ± 13 (107-159)	138 ± 19 (100-176)
PV S/D ratio	0.82 ± 0.18 (0.46-1.18)	0.98 ± 0.32 (0.34-1.62)	1.21 ± 0.2 (0.81-1.61)	1.39 ± 0.47 (0.45-2.33)
PV Ar (cm/s)	16 ± 10 (1-36)	21 ± 8 (5-37)	23 ± 3 (17-29)	25 ± 9 (11-39)
PV Ar duration (ms)	66 ± 39 (1-144)	96 ± 33 (30-162)	112 ± 15 (82-142)	113 ± 30 (53-173)
Septal e´ (cm/s)	14.9 ± 2.4 (10.1-19.7)	15.5 ± 2.7 (10.1-20.9)	12.2 ± 2.3 (7.6-16.8)	10.4 ± 2.1 (6.2-14.6)
Septal e´/a´ ratio	2.4*	1.6 ± 0.5 (0.6-2.6)	1.1 ± 0.3 (0.5-1.7)	0.85 ± 0.2 (0.45-1.25)
Lateral e´ (cm/s)	20.6 ± 3.8 (13-28.2)	19.8 ± 2.9 (14-25.6)	16.1 ± 2.3 (11.5-20.7)	12.9 ± 3.5 (5.9-19.9)
Lateral e´/a´ ratio	3.1*	1.9 ± 0.6 (0.7-3.1)	1.5 ± 0.5 (0.5-2.5)	0.9 ± 0.4 (0.1-1.7)
Data are expressed as mean ± SD (95% confidence interval). Note that for e´ velocity in subjects aged 16 to 20 years, values overlap with those for subjects aged 21 to 40 years. This is because e´ increases progressively with age in children and adolescents. Therefore, the e´ velocity is higher in a normal 20-year-old than in a normal 16-year-old, which results in a somewhat lower average e´ value when subjects aged 16 to 20 years are considered.
* Standard deviations are not included because these data were computed, not directly provided in the original articles from which they were derived.

Grading diastolic function

Grading LV diastolic function with normal LVEF.
Estimation LV Filling Pressures with depressed LVEF or normal LVEF with diastolic dysfunction.

References

JASE 2015 Jan;28(1):1-39.e14

Eur Heart J Cardiovasc Imaging. 2016 Dec;17(12):1321-1360

JACC Cardiovasc Imaging. 2009 Jan;2(1):80-4