What are normal echocardiogram (ECHO) results?

From the Guidelines

A normal echocardiogram (ECHO) typically shows a left ventricular ejection fraction (LVEF) of 55-70%, with normal chamber sizes and wall thicknesses, as recommended by the European Association of Cardiovascular Imaging 1. The left ventricle should measure 3.5-5.7 cm in diastole with wall thickness of 0.6-1.0 cm.

• The right ventricle should be smaller than the left ventricle, measuring 2.0-2.8 cm.
• All four heart valves (mitral, aortic, tricuspid, and pulmonic) should demonstrate normal structure without stenosis or regurgitation beyond trivial or mild levels.
• The aortic root typically measures 2.0-3.7 cm, and the left atrium 2.7-3.8 cm.
• Normal diastolic function shows an E/A ratio between 0.8 and 2.0, with normal tissue Doppler velocities, as outlined in the 2017 standardization of adult transthoracic echocardiography reporting 1. No wall motion abnormalities should be present, with all segments contracting symmetrically.
• The pericardium should appear as a thin echo-dense line without effusion, and there should be no visible masses, thrombi, or congenital abnormalities. These parameters represent normal cardiac structure and function, providing a baseline for comparison when evaluating potential cardiac pathologies, and are in agreement with the 2015 chamber quantification and 2016 diastolic function recommendations 1.

From the Research

Normal ECHO Results

Normal ECHO results can be defined by various parameters, including:

• Left ventricular ejection fraction (LVEF): a measure of how well the left ventricle pumps blood with each contraction. According to 2, the normal modal LVEF is around 62%.
• Left ventricular end-diastolic pressure (LVEDP): the pressure in the left ventricle at the end of diastole. The LVEF/LVEDP ratio has been shown to be a predictor of long-term prognosis after ST-segment elevation acute myocardial infarction 3.
• Longitudinal, circumferential, and radial peak systolic strain values: measures of myocardial deformation. Reference values for these parameters have been established in healthy adults, with average values of -21.5% for global longitudinal strain, 40.1% for radial strain, and -22.2% for circumferential strain 4.
• Left ventricular rotation and twist: measures of rotational mechanics. Mean rotational values have been reported as -6.9° for the base, 13.0° for apical rotation, and 20.0° for net twist 4.

Reference Values

Reference values for normal ECHO results include:

• LVEF: 62% or higher 2
• LVEF/LVEDP ratio: higher ratios are associated with better prognosis 3
• Global longitudinal strain: -16.9% or lower for men, -18.5% or lower for women 4
• Radial strain: 24.6% or higher 4
• Circumferential strain: -15.4% or lower 4
• Left ventricular rotation and twist: -6.9° for the base, 13.0° for apical rotation, and 20.0° for net twist 4

Clinical Implications

Normal ECHO results can have important clinical implications, including:

• Predicting long-term prognosis after ST-segment elevation acute myocardial infarction 3
• Identifying patients at risk for adverse outcomes 5
• Guiding management and treatment decisions 5