Normal Values in Echocardiogram
Normal values in echocardiography include left ventricular ejection fraction (LVEF) of 53-73%, left ventricular end-diastolic volume index (LVEDVi) of <80 mL/m² for men and <72 mL/m² for women, and left ventricular end-systolic volume index (LVESVi) of <33 mL/m² for men and <29 mL/m² for women. 1
Left Ventricular Parameters
Left Ventricular Ejection Fraction (LVEF)
- Normal LVEF is 63 ± 5% using the biplane method of disks 1
- The normal range is 53-73% for adults over 20 years of age 1
- 3D echocardiography normal values: >54% for men and >57% for women 1
- LVEF is not significantly related to gender, age, or body size 1
- Qualitative descriptions of LVEF include: 1
- Normal: Normal proportion of blood ejected
- Hyperdynamic: Greater than normal proportion ejected
- Mildly reduced: Slightly reduced proportion compared to normal
- Moderately reduced: Moderately smaller proportion than normal
- Severely reduced: Considerably less proportion than normal
Left Ventricular Volumes
- Left ventricular end-diastolic volume index (LVEDVi): 1
- 3D normal values: <80 mL/m² for men, <72 mL/m² for women
- Left ventricular end-systolic volume index (LVESVi): 1
- 3D normal values: <33 mL/m² for men, <29 mL/m² for women
- Men typically have larger LV volumes than women 2
- Significant intercountry variation exists for LV volumes even after indexing to body surface area 2
Left Ventricular Dimensions
- Normal ranges for LV dimensions are smaller than those in previous guidelines 2
- LV dimensions should be normalized for body surface area (BSA) 1
- LV internal dimensions are measured at the base of the left ventricle 1
Left Ventricular Wall Thickness
- Interventricular septum thickness (IVST) and posterior wall thickness (PWT) are important measurements for assessing LV hypertrophy 1
- These measurements should be obtained from the parasternal long-axis view 1
- Measurements should be made at end-diastole 1
Advanced Echocardiographic Parameters
Global Longitudinal Strain (GLS)
- Normal LV GLS: >20% (absolute value) 1
- GLS measurements should be made in the three standard apical views and averaged 1
- GLS is higher in magnitude in women than men 3
- When regional tracking is suboptimal in more than two myocardial segments in a single view, GLS calculation should be avoided 1
Right Ventricular Parameters
- Right ventricular free wall GLS: >23% (absolute value) 1
- TAPSE (Tricuspid Annular Plane Systolic Excursion) is an important measure of RV function 1
Demographic Considerations
- Age, sex, and race should be considered when defining normal reference values 3
- Men have larger LV volumes and lower LVEFs than women 2, 3
- LV volumes are lower and LVEF tends to be higher with increasing age 3
- Asians typically have smaller chamber sizes and higher LVEFs compared to both blacks and whites 3
Technical Considerations
- The quality of cardiac imaging should be reported (optimal, fair, suboptimal, or poor) 1
- Vendor and model of the echo machine should be reported due to inter-vendor variability 1
- 3D echocardiography has been shown to be more accurate and reproducible than 2D echocardiography for volume measurements 3
- Contrast 2D echo and noncontrast 3D echo show good reproducibility and agreement with cardiac magnetic resonance (CMR) measurements of LVEF 4
Common Pitfalls and Caveats
- Measurements should be indexed to body surface area for accurate interpretation 1
- The report should include normal reference values to differentiate normal from pathological conditions 1
- Avoid reporting the same parameter using different ultrasound techniques 1
- Low normal LVEF (50-55%) is associated with increased risk for incident congestive heart failure compared to normal LVEF (≥55%) 5
- Serial assessment of GLS in individual patients should be performed using the same vendor's equipment and software due to intervendor variability 1
- Variation over time should be interpreted carefully, considering the reproducibility of the parameters used 1