• LV size
• LV mass
• LV geometry

LV systolic function

• LV function
• 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

Reference limits and partition values of left ventricular size
	MEN				WOMEN
	Reference	Mildly	Moderately	Severely	Reference	Mildly	Moderately	Severely
	Range	Abnormal	Abnormal	Abnormal	Range	Abnormal	Abnormal	Abnormal
LV dimension
LV diastolic diameter, cm	4.2–5.8	5.9–6.3	6.4–6.8	≥6.9	3.8–5.2	5.3–5.6	5.7–6.1	≥6.2
LV diastolic diameter/BSA, cm/m2	2.2–3.0	3.1–3.3	3.4–3.6	≥3.7	2.3–3.1	3.2–3.4	3.5–3.7	≥3.8
LV systolic diameter	2.5–4.0	4.1–4.3	4.4–4.5	≥4.6	2.2–3.5	3.6–3.8	3.9–4.1	≥4.2
LV systolic diameter/BSA, cm/m2	1.3–2.1	2.2–2.3	2.4–2.5	≥2.6	1.3–2.1	2.2–2.3	2.4–2.6	≥2.7
LV volume
LV diastolic volume, mL	62–150	151–174	175–200	≥201	46–106	107–120	121–130	≥131
LV diastolic volume/BSA, mL/m2	34–74	75–89	90–100	≥101	29–61	62–70	71–80	≥81
LV systolic volume, mL	21–61	62–73	74–85	≥86	14–42	43–55	56–67	≥68
LV systolic volume/BSA, mL/m2	11–31	32–38	39–45	≥46	8–24	25–32	33–40	≥41

 

LV Mass

Reference limits and values and partition values of left ventricular mass
	MEN				WOMEN
	Reference	Mildly	Moderately	Severely	Reference	Mildly	Moderately	Severely
	Range	Abnormal	Abnormal	Abnormal	Range	Abnormal	Abnormal	Abnormal
Linear Method
LV mass, g	88–224	225–258	259–292	≥293	67–162	163–186	187–210	≥211
LV mass/BSA, g/m2	49–115	116–131	132–148	≥149	43–95	96–108	109–121	≥122
Relative wall thickness, cm	0.24–0.42	0.43–0.46	0.47–0.51	≥0.52	0.22–0.42	0.43–0.47	0.48–0.52	≥0.53
Septal thickness, cm	0.6–1.0	1.1–1.3	1.4–1.6	≥1.7	0.6–0.9	1.0–1.2	1.3–1.5	≥1.6
Posterior wall thickness, cm	0.6–1.0	1.1–1.3	1.4–1.6	≥1.7	0.6–0.9	1.0–1.2	1.3–1.5	≥1.6
2D Method
LV mass, g	96–200	201–227	228–254	>255	66–150	151–171	172–182	>193
LV mass/BSA, g/m2	50–102	103–116	117–130	≥131	44–88	89–100	101–112	≥113

 

LV geometry

Reference limits and values and partition values of left ventricular geometry
	Relative wall thickness	Left ventricular mass index
		MEN	WOMEN
Normal geometry	≤0.42	≤115	≤95
Concentric remodeling	>0.42	≤115	≤95
Concentric hypertrophy	>0.42	>115	>95
Eccentric hypertrophy	≤0.42	>115	>95

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

Reference limits and values and partition values of left ventricular function
	MEN				WOMEN
	Reference	Mildly	Moderately	Severely	Reference	Mildly	Moderately	Severely
	range	abnormal	abnormal	abnormal	range	abnormal	abnormal	abnormal
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
Myocard performance index	<0.40				<0.40
dP/dt (mmHg/s)	>1100			<500	>1100			<500
Ejection fraction (%)	52 - 72	41 - 51	30 - 40	<30	54 - 74	41 - 53	30 - 40	<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 parameters, references grouping by age

Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study
Parameters	20–40 years		40–60 years		>60 years		P
	Mean±SD	95% CI	Mean±SD	95% CI	Mean±SD	95% CI
E-wave velocity (m/s)	0.82 ± 0.16	0.53–1.22	0.75 ± 0.17	0.46–1.13	0.70 ± 0.16	0.39–1.03	<0.001
A-wave velocity (m/s)	0.50 ± 0.13	0.30–0.87	0.62 ± 0.15	0.37–0.97	0.77 ± 0.16	0.40–1.04	<0.001
E-wave deceleration time (ms)	178 ± 43	105–269	187 ± 45	114–288	208 ± 62	114–385	<0.001
E/A ratio	1.71 ± 0.52	0.89–3.18	1.24 ± 0.39	0.71–2.27	0.98 ± 0.29	0.53–1.80	<0.001
Septal e' wave (cm/s)	12.1 ± 2.5	8.0–17.0	9.8 ± 2.6	5.0–16.0	7.6 ± 2.3	3.0–13.0	<0.001
Septal a' wave (cm/s)	8.5 ± 1.7	5.3–12.0	9.8 ± 2.0	6.9–14.0	10.5 ± 1.7	7.0–14.0	<0.001
Lateral e' wave (cm/s)	16.4 ± 3.4	10.0–23.0	12.5 ± 3.0	6.0–18.0	9.6 ± 2.8	4.0–17.0	<0.001
Lateral a' wave (cm/s)	8.2 ± 2.2	5.0–13.0	9.4 ± 2.6	5.0–15.0	10.6 ± 2.9	6.0–17.0	<0.001
Average septal and lateral e' wave (cm/s)	14.3 ± 2.7	9.1–19.5	11.1 ± 2.5	6.0–16.0	8.6 ± 2.3	3.5–15.0	<0.001
Septal E/e'	6.9 ± 1.6	4.4–10.6	8.1 ± 2.3	4.3–13.2	9.7 ± 2.8	5.0–16.9	<0.001
Lateral E/e'	5.1 ± 1.3	3.1–8.5	6.3 ± 2.2	3.7–12.0	7.8 ± 2.2	4.2–12.8	<0.001
Average septal and lateral E/e'	5.8 ± 1.3	3.6–9.1	7.0 ± 2.1	4.2–11.5	8.5 ± 2.2	4.6–13.5	<0.001
Average E/e'	5.6 ± 1.1	3.7–7.9	6.8 ± 1.8	4.0–11.6	8.3 ± 2.2	4.4–14.8	<0.001
P differences between groups according to age category (one-way ANOVA).

Most important cut-off values for diastolic parameters

Parameter	Cut-off value
TR Vmax	> 2.8m/s
é septal	< 7 cm/s
é lateral	< 10cm/s
E/é	>14
LAVi	> 34ml/m²
LA Reservoir Strain	< 18%

 

Grading diastolic function

Criteria for grading of LV diastolic dysfunction according to level of filling pressure and mitral flow velocities
	Grade I	Grade II	Grade III
LV filling pressure	Low or normal	Elevated	Elevated
Mitral E/A ratio	≤0.8	0.8 to 2	≥2

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

 

References

Eur Heart J Cardiovasc Imaging (2022) 23, 234-e61

Eur Heart J Cardiovasc Imaging (2017) 18, 1301-1310

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