What are the normal left ventricular internal dimension at diastole (LVIDd) values on echocardiography (echo) for men and women?

Normal Left Ventricular Internal Dimension at Diastole (LVIDd) Values on Echocardiography for Men and Women

The normal LVIDd on echocardiography ranges from 42.0-58.4 mm in men and 37.8-52.2 mm in women, with mean values of 50.2 mm for men and 45.0 mm for women. 1

Standard Reference Values

According to the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines, the normal values for LVIDd are:

• Men:

  • Mean: 50.2 ± 4.1 mm
  • Normal range (mean ± 2SD): 42.0-58.4 mm

• Women:

  • Mean: 45.0 ± 3.6 mm
  • Normal range (mean ± 2SD): 37.8-52.2 mm 2, 1

Measurement Technique

For accurate LVIDd measurements, the following technique should be used:

• Measure from 2D-guided images rather than M-mode alone
• Obtain measurements from the parasternal long-axis acoustic window
• Measure at the level of the LV minor axis, approximately at the mitral valve leaflet tips
• Position the cursor perpendicular to the long axis of the ventricle 1

Indexed Values

Body size significantly affects LVIDd measurements, making indexed values important for accurate interpretation:

• When indexed to body surface area (BSA), normal LVIDd values are:
  • Upper limit: 35.3 mm/m² for men
  • Upper limit: 40.8 mm/m² for women 2

Factors Affecting Measurement

Several factors can influence LVIDd measurements:

• Body size: LVIDd correlates with BSA (r=0.29-0.60), with indexed values typically higher in women 3
• Age: LVIDd tends to increase with age 3
• Technical factors: Improper alignment of the M-mode cursor or suboptimal acoustic windows can lead to inaccurate measurements 1

Clinical Implications

LVIDd is clinically important for:

1. LV mass calculation using the formula: LVM = 0.8 × {1.04[(LVIDd + PW + IVSd)³ - (LVIDd)³]} + 0.6 g 1

2. Relative wall thickness (RWT) assessment using: RWT = (2 × posterior wall thickness)/LVIDd 1

3. LV geometry classification into:

   • Normal geometry (normal LV mass, RWT ≤0.42)
   • Concentric remodeling (normal LV mass, RWT >0.42)
   • Eccentric hypertrophy (increased LV mass, RWT ≤0.42)
   • Concentric hypertrophy (increased LV mass, RWT >0.42) 2

Limitations of LVIDd Measurements

It's important to recognize that:

• LVIDd is a one-dimensional measurement that may not fully represent three-dimensional LV size
• Studies show limited agreement between LVIDd and volumetric measurements of LV size 4
• 3D echocardiography provides more accurate volume measurements without geometric assumptions 2, 5

Alternative Approaches

When LVIDd measurements are unreliable or when more accurate assessment is needed:

• Volumetric measurements using biplane Simpson's method are preferred
• 3D echocardiography offers superior accuracy for LV size assessment 2, 5
• Length-to-diameter ratio (L/D) may be useful as a BSA-independent measure of LV geometry (normal value approximately 1.40-1.41) 3

When interpreting LVIDd measurements, always consider the patient's body size, age, and gender to ensure accurate clinical assessment.