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BSA — m²
| Parameter | Context | Tools |
|---|---|---|
| Body surface area (BSA) | ||
| BSA (m²) = √(height cm × weight kg / 3600) (Mosteller) | ||
| Body mass index (BMI) | ||
| BMI (kg/m²) = weight kg / height m² | ||
All calculators in this section (1)
2. LV size, geometry and mass
Left ventricle ›| Parameter | Context | Normal | Other / abnormal | Tools |
|---|---|---|---|---|
| LV internal diameter, end-diastole (LVIDd) cm | Men | ≥ 4.2 and ≤ 5.84 | Below 2-SD range: < 4.2 Above 2-SD range: > 5.84 | |
| Women | ≥ 3.78 and ≤ 5.22 | Below 2-SD range: < 3.78 Above 2-SD range: > 5.22 | ||
| LV internal diameter, end-systole (LVIDs) mm | Men | 25.0–39.8 | ||
| Women | 21.6–34.8 | |||
| LV end-diastolic volume index (EDV/BSA) mL/m² | Men | ≥ 34 and ≤ 74 | Below 2-SD range: < 34 Above 2-SD range: > 74 | |
| Women | ≥ 29 and ≤ 61 | Below 2-SD range: < 29 Above 2-SD range: > 61 | ||
| LV end-systolic volume index (ESV/BSA) mL/m² | Men | ≥ 11 and ≤ 31 | Below 2-SD range: < 11 Above 2-SD range: > 31 | |
| Women | ≥ 8 and ≤ 24 | Below 2-SD range: < 8 Above 2-SD range: > 24 | ||
| LV mass index (linear method) (LVMi) g/m² | Men | ≥ 49 and ≤ 115 | Below reference range: < 49 Increased: > 115 | |
| Women | ≥ 43 and ≤ 95 | Below reference range: < 43 Increased: > 95 | ||
| LV mass (g) = 0.8 × 1.04 × [(IVSd + LVIDd + PWd)³ − LVIDd³] + 0.6, dimensions in cm | ||||
| Relative wall thickness (RWT) | ≤ 0.42 | > 0.42: > 0.42 | ||
| RWT = 2 × PWd / LVIDd | ||||
| LV geometry (mass index and RWT) | Normal mass index | RWT ≤ 0.42: normal geometry · RWT > 0.42: concentric remodeling | ||
| Increased mass index | RWT ≤ 0.42: eccentric hypertrophy · RWT > 0.42: concentric hypertrophy | |||
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3. LV systolic function, wall motion and strain
Sources:ASE/EACVI 2025 · Clinical applications of strainASE/EACVI 2015 · Cardiac chamber quantification
Left ventricle ›| Parameter | Context | Normal | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|---|
| LV ejection fraction (LVEF) % | Men | ≥ 52 and ≤ 72 | ≥ 41 and < 52 | ≥ 30 and < 41 | < 30 | Above normal range: > 72 | |
| Women | ≥ 54 and ≤ 74 | ≥ 41 and < 54 | ≥ 30 and < 41 | < 30 | Above normal range: > 74 | ||
| EF = (EDV − ESV) / EDV | |||||||
| Serial LVEF change (ΔEF) | |||||||
| ΔEF = current EF − baseline EF, expressed in percentage points with explicit direction | |||||||
| LV global longitudinal strain (GLS) % | 2025 consensus (not a guideline) | < -18 | Borderline: ≥ -18 and ≤ -16 Abnormal: > -16 | ||||
| Lagrangian strain (%) = (Lt − L0)/L0; GLS is measured in the three apical views and averaged | |||||||
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4. Left atrial dimensions and function
Sources:ASE 2025 · LV diastolic function and HFpEFASE/EACVI 2015 · Cardiac chamber quantificationASE/EACVI 2025 · Clinical applications of strain+1 more
Atria and diastolic function ›| Parameter | Context | Normal | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|---|
| LA volume index (LAVI) mL/m² | ≥ 16 and ≤ 34 | > 34 and ≤ 41 | > 41 and ≤ 48 | > 48 | Below normal range: < 16 | ||
| LAVI = LA maximum volume / BSA | |||||||
| LA diameter and area (LA AP) | |||||||
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5. Diastolic function and filling pressures
Sources:ASE 2025 · LV diastolic function and HFpEFHFA–PEFF 2019 · ESC Heart Failure AssociationDoppler tissue imaging and filling pressures 1997 · Nagueh et al.+1 more
Atria and diastolic function ›Pathways:
| Parameter | Context | Normal | Mild | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|
| Diastolic function grade and LAP (sinus rhythm) (Figure 3) | Primary variables (e′, E/e′, TR velocity or PASP) | All three normal: normal LAP and normal diastolic function. Reduced e′ only: E/A. Increased TR/PASP only, increased E/e′ only, or any two abnormal: additional variables. All three abnormal: increased LAP. | ||||
| Additional variables (PV S/D, LARS, LAVi) | At least one present: LAP increased. None present: LAP normal. IVRT is an alternative marker; if none is available or reliable, the supplemental methods are used. | |||||
| Grade 1 | Reduced e′ only with a low E/A (see E/A): normal LAP and grade 1 diastolic dysfunction. Reduced e′ only with a higher E/A: additional variables. | |||||
| Grade 2 and 3 (LAP increased) | Graded by E/A: grade 2 is a mild/moderate increase in LAP; grade 3 is a marked increase in LAP. | |||||
| Mitral early diastolic inflow velocity (E) | ||||||
| Mitral E/A ratio (E/A) | ≤ 0.8 | ≥ 2 | >0.8 and <2: > 0.8 and < 2 | |||
| Mitral annular e′ velocity (e′) cm/s | Septal | > 6 | Reduced: ≤ 6 | |||
| Lateral | > 7 | Reduced: ≤ 7 | ||||
| Average | > 6.5 | Reduced: ≤ 6.5 | ||||
| Mitral E/e′ ratio (E/e′) | Septal | < 15 | Increased: ≥ 15 | |||
| Lateral | < 13 | Increased: ≥ 13 | ||||
| Average | < 14 | Increased: ≥ 14 | ||||
| Average E/e′, general interpretation | <8 usually indicates normal LV filling pressures | 8 to 14: gray zone (indeterminate); >14 has high specificity for increased pressures | ||||
| E/e′ = mitral E velocity / TDI e′; average E/e′ uses the average of septal and lateral e′ | ||||||
| Peak TR velocity and PASP (diastolic criterion) (TR Vmax) | TR velocity · m/s | < 2.8 | Increased: ≥ 2.8 | |||
| PASP · mmHg | < 35 | Increased: ≥ 35 | ||||
| LAVi (diastolic criterion) (LAVi) mL/m² | ≤ 34 | >34 mL/m²: > 34 | ||||
| LAP in atrial fibrillation (Figure 8) (AF) | Stage 1: mitral E velocity · cm/s | < 100 | ≥100 cm/s: ≥ 100 | |||
| Stage 1: septal E/e′ | ≤ 11 | >11: > 11 | ||||
| Stage 1: peak TR velocity · m/s | ≤ 2.8 | >2.8 m/s: > 2.8 | ||||
| Stage 1: PASP · mmHg | ≤ 35 | >35 mmHg: > 35 | ||||
| Stage 1: DT · ms | > 160 | ≤160 ms: AF variable present: ≤ 160 | ||||
| Stage 1 count | None or 1 present: normal LAP. 2 present: go to stage 2. 3 or more present: elevated LAP. | |||||
| Stage 2: LARS · % | ≥ 18 | <18%: < 18 | ||||
| Stage 2: PV S/D | ≥ 1 | <1: < 1 | ||||
| Stage 2: BMI · kg/m² | ≤ 30 | >30 kg/m²: > 30 | ||||
| Stage 2 count | 2 of 3 or 3 of 3 present: elevated LAP. None: normal LAP. 1 only, or not available or not reliable: indeterminate. | |||||
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6. Right atrial size and function
Sources:ASE 2025 · Right heart and pulmonary hypertensionASE/EACVI 2025 · Clinical applications of strainASE/EACVI 2015 · Cardiac chamber quantification
Right heart and pulmonary pressures ›| Parameter | Context | Normal | Mild | Moderate | Severe | Tools |
|---|---|---|---|---|---|---|
| RA major and minor dimensions cm | Major (long-axis) dimension | < 5.4 | ≥ 5.4 and ≤ 5.8 | > 5.8 and ≤ 6.3 | > 6.3 | |
| Minor (transverse) dimension | < 4.2 | ≥ 4.2 and ≤ 4.7 | > 4.7 and ≤ 5.1 | > 5.1 | ||
| RA end-systolic area (RA area) cm² | < 19 | ≥ 19 and ≤ 22 | > 22 and ≤ 24 | > 24 | ||
| RA volume index (RAV index) mL/m² | Single-plane method of disks | < 30 | ≥ 30 and ≤ 36 | > 36 and ≤ 41 | > 41 | |
| Area-length method | < 33 | ≥ 33 and ≤ 38 | > 38 and ≤ 44 | > 44 |
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7. RV size and systolic function
Right heart and pulmonary pressures ›| Parameter | Context | Normal | Mild | Moderate | Severe | Tools |
|---|---|---|---|---|---|---|
| RV basal diameter (RV basal) | Absolute · cm | < 4.1 | ≥ 4.1 and ≤ 4.4 | > 4.4 and ≤ 4.9 | > 4.9 | |
| Indexed to BSA · cm/m² | < 2.4 | ≥ 2.4 and ≤ 2.6 | > 2.6 and ≤ 2.9 | > 2.9 | ||
| RV midventricular diameter (RV mid) cm | < 3.5 | ≥ 3.5 and ≤ 3.8 | > 3.8 and ≤ 4.2 | > 4.2 | ||
| RV longitudinal dimension (RV length) cm | < 8.2 | ≥ 8.2 and ≤ 8.9 | > 8.9 and ≤ 9.6 | > 9.6 | ||
| RVOT diameter (RVOT) cm | Proximal, PLAX | < 3.3 | ≥ 3.3 and ≤ 3.5 | > 3.5 and ≤ 3.9 | > 3.9 | |
| Proximal, PSAX | < 3.4 | ≥ 3.4 and ≤ 3.8 | > 3.8 and ≤ 4.1 | > 4.1 | ||
| Distal, PSAX | < 2.9 | ≥ 2.9 and ≤ 3 | > 3 and ≤ 3.3 | > 3.3 | ||
| RV fractional area change (FAC) % | > 35 | > 29 and ≤ 35 | > 22 and ≤ 29 | ≤ 22 | ||
| FAC (%) = [(RVEDA − RVESA) / RVEDA] × 100 | ||||||
| Tricuspid annular plane systolic excursion (TAPSE) cm | > 1.7 | > 1.3 and ≤ 1.7 | > 1 and ≤ 1.3 | ≤ 1 | ||
| RV tissue Doppler S′ velocity (S′) cm/s | > 9.5 | > 7.2 and ≤ 9.5 | > 5 and ≤ 7.2 | ≤ 5 | ||
| Integrated RV systolic function | ||||||
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8. RAP, pulmonary pressures and RV–PA coupling
Right heart and pulmonary pressures ›Pathways:
| Parameter | Context | Normal | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|---|
| Right atrial pressure (RAP) mmHg | IVC ≤2.1 cm, collapse ≥50% with sniff | RAP 3 (range 0–5) | |||||
| IVC >2.1 cm, collapse <50% with sniff | RAP 15 (range 10–20) | ||||||
| Indeterminate pattern | RAP 8 (range 5–10), integrated with secondary indices | ||||||
| IVC >2.5 cm without variation, with spontaneous echo contrast or color reflux | RAP 20 may be considered | ||||||
| TR peak velocity (TR Vmax) m/s | < 2.8 | ≥ 2.8 and ≤ 3.1 | > 3.1 and ≤ 3.5 | > 3.5 | |||
| RV systolic pressure (RVSP) mmHg | ≤ 34 | > 34 and ≤ 49 | > 49 and ≤ 69 | > 69 | |||
| RVSP = 4 × (peak TR velocity)² + RAP | |||||||
| Pulmonary artery systolic pressure (PASP) | |||||||
| PASP = RVSP only in the absence of RVOT or pulmonic valve obstruction | |||||||
| Pulmonary hypertension: echocardiographic probability (PH) | Resting peak TR velocity | ≥2.9 m/s suggests PH in the absence of RVOT obstruction | |||||
| With at least two adjunctive echo signs | Peak TR velocity ≥2.8 m/s is suggestive of PH and warrants further investigation | ||||||
| Grading by RVSP when PH is suspected (mmHg) | ≥35 to ≤49 | ≥50 to ≤69 | ≥70 | ||||
| Adjunctive signs | RA area >18 cm²; RVOT AccT <105 ms; RV dilation and/or hypertrophy (for example RV basal diameter greater than LV basal diameter); IVC dilation with abnormal respirophasic variation; HVs/HVd <1; LV eccentricity index >1; main PA >25 mm; mid-systolic notching or mid-late peaking of the RVOT Doppler signal | ||||||
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9. LVOT and general Doppler hemodynamics
Sources:EACVI/ASE 2017 · Aortic stenosis (focused update)ASE 2019 · Comprehensive TTE examinationASE 2025 · Adult echocardiography reporting+1 more
Native valves ›| Parameter | Context | Normal | Other / abnormal | Tools |
|---|---|---|---|---|
| LVOT diameter and cross-sectional area (LVOTd) | ||||
| CSA = π × (D/2)² | ||||
| LVOT velocity-time integral (LVOT VTI) | ||||
| Stroke volume (LVOT Doppler) (SV) | ||||
| SV = CSA(LVOT) × VTI(LVOT) | ||||
| Stroke volume index and flow state (SVi) mL/m² | ≥ 35 and ≤ 58 | Low flow: < 35 High flow: > 58 | ||
| SVi = SV / BSA | ||||
| Cardiac output and cardiac index (CO, CI) | ||||
| CO (L/min) = SV (mL) × HR (bpm) / 1000; CI = CO / BSA | ||||
| Peak pressure gradient (simplified Bernoulli) (ΔPmax) | ||||
| ΔPmax = 4 × V²max; with proximal correction ΔPmax = 4 × (V²max − V²proximal) | ||||
| Mean pressure gradient (method) (ΔPmean) | ||||
| Mean gradient = average of the instantaneous gradients over the ejection period from the traced velocity curve | ||||
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| Parameter | Context | Normal | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|---|
| AS peak velocity (Vmax) m/s | ≤ 2.5 | > 2.5 and < 3 | ≥ 3 and < 4 | ≥ 4 | |||
| AS mean gradient (ΔPmean) mmHg | < 20 | ≥ 20 and < 40 | ≥ 40 | ||||
| Aortic valve area (continuity) (AVA) cm² | > 1.5 | ≥ 1 and ≤ 1.5 | < 1 | ||||
| AVA = CSA(LVOT) × VTI(LVOT) / VTI(AV) | |||||||
| Indexed aortic valve area (AVAi) cm²/m² | > 0.85 | ≥ 0.6 and ≤ 0.85 | < 0.6 | ||||
| AVAi = AVA / BSA | |||||||
| Velocity ratio (dimensionless index) (V_LVOT / V_AV) | > 0.5 | ≥ 0.25 and ≤ 0.5 | < 0.25 | ||||
| Velocity ratio = V_LVOT / V_AV (equivalently the VTI ratio) | |||||||
| Integrating AS severity criteria | Any one suggests severe AS | AVA <1.0 cm²; peak velocity ≥4.0 m/s; mean gradient ≥40 mmHg | |||||
| Flow state in AS (SVi) (SVi) mL/m² | Flow state | ≥ 35 and ≤ 58 | Low flow: < 35 High flow: > 58 | ||||
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Pathways:
| Parameter | Context | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|
| AR vena contracta width (VCW) cm | < 0.3 | ≥ 0.3 and ≤ 0.6 | > 0.6 | |||
| AR jet width / LVOT width (Jet/LVOT width) % | < 25 | ≥ 25 and < 46 ≥ 46 and < 65 | ≥ 65 | |||
| Ratio (%) = AR jet width / LVOT width × 100, parasternal long axis just apical to the valve | ||||||
| AR pressure half-time (PHT) ms | > 500 | ≥ 200 and ≤ 500 | < 200 | |||
| AR effective regurgitant orifice area (EROA) cm² | < 0.1 | ≥ 0.1 and < 0.2 ≥ 0.2 and < 0.3 | ≥ 0.3 | |||
| EROA = regurgitant flow rate / peak AR velocity in early diastole; EROA = RVol / VTI(AR jet) | ||||||
| AR regurgitant volume (RVol) mL | < 30 | ≥ 30 and < 45 ≥ 45 and < 60 | ≥ 60 | |||
| RVol = SV(aortic, LVOT) − SV(mitral annulus or RVOT) | ||||||
| AR regurgitant fraction (RF) % | < 30 | ≥ 30 and < 40 ≥ 40 and < 50 | ≥ 50 | |||
| RF = RVol / SV(regurgitant valve) × 100 | ||||||
| AR specific signs of mild and severe (Figure 25) | Specific signs | VC width <0.3 cm; central jet width <25% of LVOT; small or no flow convergence; soft or incomplete jet by CW; PHT >500 ms; normal LV size | Flail valve; VC width >0.6 cm; central jet width ≥65% of LVOT; large flow convergence; PHT <200 ms; prominent holodiastolic flow reversal in the descending aorta; enlarged LV with normal function | |||
| Number of criteria | 4 or more: definitely mild or severe; 2–3 or intermediate values: probably moderate, quantify | |||||
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12. Mitral regurgitation
Sources:ASE 2017 · Native valvular regurgitationASE 2019 · Regurgitation after percutaneous repair/replacementASE 2026 · Intraprocedural M-TEER imaging
Native valves ›Pathways:
| Parameter | Context | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|
| MR vena contracta width (VCW) cm | Single view | < 0.3 | ≥ 0.3 and < 0.7 | ≥ 0.7 | ||
| Average of apical two- and four-chamber views | > 0.8 | Not above the biplane severe cutoff: ≤ 0.8 | ||||
| MR flow-convergence (PISA) radius (PISA radius) cm | < 0.3 | ≥ 0.3 and < 1 | ≥ 1 | |||
| MR effective regurgitant orifice area (PISA) (EROA) cm² | < 0.2 | ≥ 0.2 and < 0.3 ≥ 0.3 and < 0.4 | ≥ 0.4 | |||
| EROA = 6.28 × r² × Va / V_peak (r in cm; velocities in cm/s) | ||||||
| MR regurgitant volume (RVol) mL | < 30 | ≥ 30 and < 45 ≥ 45 and < 60 | ≥ 60 | |||
| RVol = EROA × VTI(regurgitant jet); or RVol = SV(LV total, EDV − ESV) − SV(forward, aortic) | ||||||
| MR regurgitant fraction (RF) % | < 30 | ≥ 30 and < 40 ≥ 40 and < 50 | ≥ 50 | |||
| RF = RVol / SV(regurgitant valve) × 100 | ||||||
| MR specific signs of mild and severe (Figure 18) | Specific signs | Small, narrow central jet; VCW ≤0.3 cm; PISA radius absent or ≤0.3 cm at Nyquist 30–40 cm/s; mitral A-wave dominant inflow; soft or incomplete jet by CW; normal LV and LA size | Flail leaflet; VCW ≥0.7 cm; PISA radius ≥1.0 cm at Nyquist 30–40 cm/s; central large jet >50% of LA area; pulmonary vein systolic flow reversal; enlarged LV with normal function | |||
| Number of criteria | 4 or more: definitely mild or severe; 2–3 or intermediate values: probably moderate, quantify | |||||
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13. Mitral stenosis
Sources:ASE 2023 · Rheumatic heart diseaseEAE/ASE 2009 · Valve stenosisASE 2025 · Right heart and pulmonary hypertension+1 more
Native valves ›Pathways:
| Parameter | Context | Mild | Moderate | Severe | Tools |
|---|---|---|---|---|---|
| Mitral valve area (rheumatic MS) (MVA) cm² | Rheumatic MS | > 2.5 | > 1.5 and ≤ 2.5 | ≤ 1.5 | |
| MVA by planimetry (MVA planimetry) | |||||
| Mitral pressure half-time (rheumatic MS) (PHT) ms | Rheumatic MS | < 100 | ≥ 100 and < 150 | ≥ 150 | |
| MVA (cm²) = 220 / PHT (ms) | |||||
| Mitral mean gradient (rheumatic MS) (Mean gradient) mmHg | At 60–80 bpm | < 5 | ≥ 5 and < 10 | ≥ 10 | |
| Pulmonary artery systolic pressure in MS (PASP) mmHg | Rheumatic MS | < 30 | ≥ 30 and < 50 | ≥ 50 | |
| PASP = RVSP = 4 × (peak TR velocity)² + RAP, only without RVOT or pulmonic obstruction | |||||
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14. Tricuspid and pulmonic valves
Sources:ASE 2017 · Native valvular regurgitationEAE/ASE 2009 · Valve stenosisASE 2023 · Rheumatic heart disease+1 more
Native valves ›Pathways:
| Parameter | Context | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|
| Pulmonic stenosis: peak velocity and peak gradient (PS Vmax / ΔPpeak) | Peak velocity · m/s | < 3 | ≥ 3 and ≤ 4 | > 4 | ||
| Peak gradient · mmHg | < 36 | ≥ 36 and ≤ 64 | > 64 | |||
| ΔPpeak = 4 × Vmax²; PASP = RVSP − ΔPpeak (pulmonic valve gradient) | ||||||
| TR vena contracta width (TR VCW) cm | ASE grading | < 0.3 | ≥ 0.3 and < 0.7 | ≥ 0.7 | ||
| TR colour jet area (TR jet area) cm² | ASE grading | > 10 | Not defined for mild or moderate: ≤ 10 | |||
| TR effective regurgitant orifice area and regurgitant volume (TR EROA / RVol) | EROA (2D PISA) · cm² | < 0.2 | ≥ 0.2 and < 0.4 | ≥ 0.4 | ||
| Regurgitant volume (2D PISA) · mL | < 30 | ≥ 30 and < 45 | ≥ 45 | |||
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15. Prosthetic aortic valves
Sources:ASE 2024 · Prosthetic valve functionASE 2019 · Regurgitation after percutaneous repair/replacementProsthesis–patient mismatch review 2024 · Hahn & Pibarot
Prosthetic and repaired valves ›| Parameter | Context | Normal | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|
| Prosthetic aortic valve peak velocity (Vmax) m/s | Prosthetic AV | < 3 | ≥ 4 | Possible stenosis: ≥ 3 and < 4 | ||
| Prosthetic aortic valve mean gradient (surgical) (Mean gradient) mmHg | Surgical prosthesis (SAVR) | < 20 | ≥ 35 | Possible stenosis: ≥ 20 and ≤ 34 Between printed ranges: > 34 and < 35 | ||
| Prosthetic aortic valve Doppler velocity index (DVI) | Surgical prosthesis (SAVR) | > 0.35 | < 0.25 | Possible stenosis: ≥ 0.25 and ≤ 0.35 | ||
| DVI = VTI_LVOT / VTI_PrAV | ||||||
| Prosthetic aortic valve acceleration time and AT/ET (AT, AT/ET) ms | Acceleration time | < 80 | > 100 | Possible stenosis: ≥ 80 and ≤ 100 | ||
| AT/ET | < 0.32 | > 0.37 | Possible stenosis: ≥ 0.32 and ≤ 0.37 | |||
| Prosthetic aortic valve effective orifice area (EOA) | ||||||
| EOA = SV / VTI_PrAV, with SV = 0.785 × d_LVOT² × VTI_LVOT | ||||||
| Aortic prosthesis-patient mismatch (indexed EOA) (EOAi) cm²/m² | BMI <30 kg/m² | > 0.85 | ≥ 0.66 and ≤ 0.85 | ≤ 0.65 | Between printed ranges: > 0.65 and < 0.66 | |
| BMI ≥30 kg/m² | > 0.7 | ≥ 0.56 and ≤ 0.7 | ≤ 0.55 | Between printed ranges: > 0.55 and < 0.56 | ||
| Indexed EOA = measured EOA (continuity) / BSA | ||||||
| Transcatheter aortic valve: change from baseline (Δ mean gradient, Δ DVI, Δ EOA) | Mean gradient | Change <10 mmHg | Increase ≥20 mmHg | Possible stenosis: increase 10–19 mmHg | ||
| DVI | Change <0.1 or 20% | Decrease ≥0.2 or ≥40% | Possible stenosis: decrease 0.1–0.19 or 20–39% | |||
| EOA | Change <0.3 cm² or 25% | Decrease ≥0.6 cm² or ≥50% | Possible stenosis: decrease 0.3–0.59 cm² or 25–49% | |||
| Baseline = TTE under stable hemodynamic conditions, 1–3 months after the procedure | ||||||
| Hemodynamic criteria for structural valve deterioration versus baseline (SVD criteria (Table 6)) | Mean gradient | Significant: increase ≥20 mmHg resulting in ≥30 mmHg | Possible: increase ≥10 mmHg resulting in ≥20 mmHg | |||
| EOA and/or DVI | Significant: EOA decrease ≥0.6 cm² or ≥50% and/or DVI decrease ≥0.2 or ≥40% | Possible: EOA decrease ≥0.3 cm² or ≥25% and/or DVI decrease ≥0.1 or ≥20% | ||||
| Intraprosthetic AR | Significant: new or ≥2 grade increase resulting in moderate or greater to severe | Possible: new or ≥1 grade increase resulting in moderate or greater | ||||
| Criteria assume stable LV function and blood pressure; compare with the designated 1–3 month baseline study | ||||||
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16. Prosthetic mitral and tricuspid valves
Sources:ASE 2024 · Prosthetic valve functionASE 2019 · Regurgitation after percutaneous repair/replacementProsthesis–patient mismatch review 2024 · Hahn & Pibarot
Prosthetic and repaired valves ›| Parameter | Context | Normal | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|
| Prosthetic mitral valve peak early velocity (Peak E velocity) m/s | Prosthetic MV | < 1.9 | ≥ 2.5 | Possible stenosis: ≥ 1.9 and < 2.5 | |
| Prosthetic mitral valve mean gradient (Mean gradient) mmHg | Prosthetic MV | ≤ 5 | > 10 | Between printed ranges: > 5 and < 6 Possible stenosis: ≥ 6 and ≤ 10 | |
| Prosthetic mitral valve VTI ratio (VTI_PrMV / VTI_LVOT) | Prosthetic MV | < 2.2 | > 2.5 | Possible stenosis: ≥ 2.2 and ≤ 2.5 | |
| VTI ratio = VTI_PrMV / VTI_LVOT (inverse of the aortic ratio) | |||||
| Prosthetic mitral valve effective orifice area (continuity) (EOA) cm² | Prosthetic MV | ≥ 2 | < 1 | Possible stenosis: ≥ 1 and < 2 | |
| EOA = SV (LVOT) / VTI_PrMV | |||||
| Prosthetic mitral valve pressure half-time (PHT) ms | Prosthetic MV | < 130 | > 200 | Possible stenosis: ≥ 130 and ≤ 200 | |
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17. Aortic root and ascending aorta
Sources:ASE/EACVI 2015 · Thoracic aortic diseaseAortic root normal limits 2012 · Devereux et al.ASE/EACVI 2015 · Cardiac chamber quantification
Aorta ›Pathways:
| Parameter | Context | Normal | Other / abnormal | Tools |
|---|---|---|---|---|
| Sinuses of Valsalva diameter (SoV) | Men | 3.4 ± 0.3 cm | ||
| Women | 3.0 ± 0.3 cm | |||
| Men, indexed | 1.7 ± 0.2 cm/m² | |||
| Women, indexed | 1.8 ± 0.2 cm/m² | |||
| Proximal ascending aorta diameter (Asc Ao) | Men | 3.0 ± 0.4 cm | ||
| Women | 2.7 ± 0.4 cm | |||
| Men, indexed | 1.5 ± 0.2 cm/m² | |||
| Women, indexed | 1.6 ± 0.3 cm/m² | |||
| Aortic root diameter by age (upper limit of normal) cm | Men, BSA 2.0 m² | Mean 3.3 / 3.4 / 3.5 / 3.6 / 3.7 / 3.8 | Upper limit 3.7 / 3.8 / 3.9 / 4.0 / 4.1 / 4.2 (ages 15–29 / 30–39 / 40–49 / 50–59 / 60–69 / ≥70) | |
| Women, BSA 1.7 m² | Mean 2.9 / 3.0 / 3.2 / 3.2 / 3.3 / 3.4 | Upper limit 3.3 / 3.4 / 3.6 / 3.6 / 3.7 / 3.9 (ages 15–29 / 30–39 / 40–49 / 50–59 / 60–69 / ≥70) | ||
| Aortic size index (ASI) cm/m² | Turner syndrome, ascending aorta (follow annually) | >2 cm/m² | ||
| ASI (cm/m²) = diameter (cm) / BSA (m²); height index (cm/m) = diameter (cm) / height (m) | ||||
| Aortic growth and serial change mm | Inter-/intraobserver measurement variability | 1.6–5 mm | ||
| Growth (mm/year) = (current − prior diameter) / elapsed years, reported with the actual interval | ||||
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Pathways:
| Parameter | Context | Normal | Mild | Moderate | Severe | Other / abnormal | Tools |
|---|---|---|---|---|---|---|---|
| Pericardial effusion size mm | End-diastolic echo-free space | < 10 | ≥ 10 and ≤ 20 | > 20 and ≤ 25 > 25 | |||
| Tamponade: echocardiographic findings | RA collapse duration (nearly 100% sensitive and specific for clinical tamponade) | >1/3 of the cardiac cycle | |||||
| IVC plethora (expected in >90% of tamponade) | IVC >2.1 cm with <50% reduction on inspiration | ||||||
| No chamber collapse | Negative predictive value >90% | ||||||
| Respiratory variation of inflow E: tamponade (ΔE) % | Mitral E | ≤ 30 | Exceeds the usual tamponade variation: > 30 | ||||
| Tricuspid E | ≤ 60 | Exceeds the usual tamponade variation: > 60 | |||||
| Variation (%) = 100 × (E expiration − E inspiration) / E expiration, first beats of each phase, averaged over several cycles; negative for tricuspid inflow | |||||||
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19. Stress echocardiography
Sources:EACVI/ASE 2017 · Stress echocardiography in non-ischemic heart diseaseASE 2020 · Stress echocardiography in ischemic heart disease
Stress echo ›Pathways:
| Parameter | Context | Normal | Other / abnormal | Tools |
|---|---|---|---|---|
| Percent of predicted maximal heart rate (% pred HR) % | ≥ 85 | Below target: < 85 | ||
| % predicted = 100 × HR peak / HR predicted maximum; target HR = 85% of the age-predicted maximum HR | ||||
| Rate–pressure product (RPP) | ||||
| RPP = heart rate (bpm) × systolic blood pressure (mmHg); the report includes the maximum HR–systolic BP product | ||||
| Wall motion score index, rest and peak (WMSI) | Segment score 1 | Normal or hyperkinesis (systolic thickening >50%) | ||
| Segment score 2 | Hypokinesis (<40%) | |||
| Segment score 3 | Severe hypokinesis or akinesis (<10%) | |||
| Segment score 4 | Dyskinesis (paradoxical systolic motion away from the LV centre) | |||
| Segment score 5 | Aneurysmal (diastolic deformation) | |||
| Inadequate contractile reserve, dilated cardiomyopathy (ESE, DSE) | ΔWMSI <0.25 | |||
| WMSI = sum of segment scores / number of segments visualized, at each stage; ΔWMSI = peak − rest | ||||
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