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.
| Reference limits and partition values of left ventricular size | ||||||||
|---|---|---|---|---|---|---|---|---|
| Men | Women | |||||||
| Reference range | Mildly abnormal | Moderately abnormal | Severely abnormal | Reference range | Mildly abnormal | Moderately abnormal | Severely 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 |
| 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.
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.
| 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 |
| 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.
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.
| Echocardiograhic 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).
Normal reference ranges for diastolic measurements by age category
|
Parameter |
20–39 jaar |
40–60 jaar |
60–80 jaar |
|
E‑wave (m/s) |
0.54 (0.52–0.57) – 1.11 (1.07–1.16) |
0.47 (0.46–0.49) – 1.02 (0.99–1.05) |
0.39 (0.37-0.42) – 0.92 (0.88-0.96 |
|
A‑wave (m/s) |
0.24 (0.21–0.27) – 0.68 (0.63–0.72) |
0.33 (0.32–0.35) – 0.82 (0.80–0.84) |
0.43 (0.40–0.45) – 0.97 (0.93–1.00) |
|
E/A‑ratio |
0.88 (0.82–0.94) – 2.73 (2.66–2.81) |
0.39 (0.37–0.42) – 0.92 (0.88–0.96) |
0.69 (0.66–0.73) – 2.07 (2.03–2.11) |
|
e′ lateral (cm/s) |
9.9 (9.4–10.4) – 22.1 (21.5–22.8) |
7.5 (7.3–7.8) – 17.5 (17.1–17.9) |
5.2 (4.8–5.6) – 13.0 (12.4–13.5) |
|
e′ septal (cm/s) |
7.2 (6.8–7.7) – 16.4 (16.0–16.9) |
7.5 (7.3–7.8) – 17.5 (17.1–17.9) |
5.7 (5.4–5.9) – 13.5 (13.2–13.8) |
|
e′ average (cm/s) |
8.7 (8.2–9.2) – 19.1 (18.6–19.7) |
6.7 (6.4–7.0) – 15.4 (15.1–15.7) |
4.7 (4.3–5.1) – 11.7 (11.2–12.2) |
|
E/e′ lateral |
2.5 (2.0–3.0) – 6.3 (5.3–7.2) |
4.1 (3.7–4.5) – 10.6 (10.1–11.0) |
3.6 (3.4–3.9) – 9.4 (8.9–10.0) |
|
E/e′ septal |
4.0 (3.3–4.7) – 9.1 (8.2–9.9) |
4.9 (4.6–5.3) – 12.1 (11.7–12.6) |
5.9 (5.5–6.3) – 15.2 (14.7–15.7) |
|
E/e′ average |
4.0 (3.8–4.3) – 9.1 (8.5–9.7) |
4.8 (4.5–5.0) – 12.6 (12.0–13.2) |
4.6 (4.4–4.8) – 11.5 (11.2–11.9) |
|
LAVi (mL/m²) |
12.1 (10.9–13.2) – 39.4 (34.6–44.2) |
12.9 (12.2–13.5) – 38.3 (35.4–41.1) |
13.7 (12.7–14.6) – 37.1 (33.0–41.3) |
|
LAVi Simpson (mL/m²) |
12.5 (12.0–13.0) – 41.9 (38.1–45.6) |
12.9 (12.2–13.5) – 38.3 (35.4–41.1) |
13.3 (13.0–13.6) – 41.0 (38.5–43.4) |
|
LAVi A‑L (mL/m²) |
8.9 (3.9–13.9) – 20.9 (12.9–28.8) |
11.0 (8.9–13.0) – 27.1 (24.0–30.3) |
13.0 (9.9–16.0) – 33.4 (28.6–38.2) |
|
TR‑Velocity (m/s) |
1.3 (1.1–1.5) – 2.7 (2.6–2.7) |
1.7 (1.5–1.8) – 2.8 (2.7–2.8) |
1.5 (1.4–1.6) – 2.7 (2.7–2.7) |
|
LA‑strain (%) – LAS TomTec |
29.5 (27.6–31.3) – 63.2 (59.9–66.5) |
26.8 (25.6–28.0) – 57.7 (55.6–59.9) |
24.1 (22.2–26.0) – 52.3 (48.9–55.7) |
|
LA‑strain (%) – LAS EchoPAC |
29.5 (27.9–31.1) – 64.9 (59.7–70.2) |
25.3 (24.0–26.5) – 61.5 (57.4–65.6) |
25.1 (22.6–27.6) – 50.3 (47.9–52.7) |
|
Reference values are based of fifth and 95th percentile values derived from regression equations to fit summary data from persons free of cardio vascular disease or risk factors. Values displayed are: fifth percentile limit (95% confidence limits) to 95th percentile limit (95% confidence limit) |
|||
| 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% |
| 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 |
|
Disease |
Indicators of elevated LV filling pressures |
|
Atrial fibrillation |
DT <160 ms (depressed LVEF) Peak acceleration rate mitral E ≥1900 cm/s² IVRT ≤65 ms Pulmonary venous DT ≤220 ms E/Vp ≥1.4 Septal E/e' ≥11 Peak TR velocity >2.8 m/s |
|
Sinus tachycardia |
Predominant early LV filling (depressed LVEF) IVRT ≤70 ms PV systolic filling fraction ≤40% Average E/e' >14 Use compensatory pause if E/A fused |
|
Hypertrofic cardiomyopathy |
Average E/e' >14 Ar-A ≥30 ms Peak TR >2.8 m/s LAVI >34 |
|
Restrictive cardiomyopathy |
Average E/e' >14 DT <140 ms E/A >2.5 IVRT <50 ms |
|
Pulmonary hypertension |
E/A ≥2 postcapillary; E/A ≤0.8 precapillary; if 0.8-2 use lateral E/e' >13 LAVI >34 LARS <18% |
|
Mitral stenosis |
IVRT <60 ms Mitral A >1.5 m/s IVRT/TE-e' <4.2 |
|
Mitral regurgitation |
IVRT <60 ms* Ar-A ≥30 ms IVRT/TE-e' <5.6 Avg E/e'>14 if depressed EF |
|
Moderate/severe MAC |
E/A <0.8 normal; E/A >1.8 elevated; if 0.8-1.8 use IVRT ≥80 normal, <80 elevated |
|
LV assist device |
E/Aratio >2 RAP >10mmHg PASP >40mmHg Average E/é >14 or septal E/é ≥ 15 LAVI >33mL/m2 Interatrial septum position† |
|
Cardiac transplant recipients |
Avg E/é <7 normal; >14 elevated; if 7-14 use E/SRIVR ≤200 normal >200 elevated; else TR ≤2.8 normal >2.8 elevated |
|
*Specific but not sensitive indicators of elevated LV filling pressure. †LAP = RAP if the interatrial septum position is neutral. If septum bulges to right, then LAP is 5mmHg higher than RAP. If septum bulges to left, then LAP is 5mmHg lowert han RAP. |
|
The information above comes from Echocardiografie.nl. Last changed on: 9 July 2026.