Transcript
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ECHOCARDIOGRAPHY Guidelines for Valve and Chamber Quantifcation
In partnership with
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Explanatory note & references These guidelines have been developed by theEducation Committee of the British Society ofEchocardiography. They have been adapted fromthe international recommendations and guidelinesreferenced below. Where there are differencesbetween published values, or there is a lack of clearevidence, recommended values have been developedon the basis of consensus opinion.
It is vital that echocardiographic measurements
are made using standard, correct techniques andthat all values are reported and interpreted inclinical context.
Valve Quantication
Recommendations for the echocardiographicassessment of native valvular regurgitation: anexecutive summary from the European Association ofCardiovascular Imaging.Lancelotti et al EHJ-CI 2013; 14:611-644
Guidelines on the management of valvular heartdisease (version 2012). The Joint Task Force onthe Management of Valvular Heart Disease of theEuropean Society of Cardiology (ESC) and the EuropeanAssociation for Cardio-Thoracic Surgery(EACTS).Vahanian et al EHJ 2012; 33:2451-2496
Aortic DimensionsAdapted from: Two-dimensional echocardiographic aortic root
dimensions in normal children and adults. Roman MJet al. Am J Cardiol 1989;64 :50712
Echocardiography in aortic diseases:EAE recommendations for clinical practiceEvangelista et al EJE 2010; 11:645-658
Valve Quantication
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Aortic stenosis
Mild Moderate Severe
4.0
40
1.5-2.0 1.0-1.4
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Aortic regurgitation
Valve Quantication
Mild Moderate Severe
0.6
500
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Aortic dimensions
Z score (BSA indexed): Dilated - >2.1cm 2 /m 2
A o r t
i c s i n u s e s
d i a m e t e r ( c m
)
4.2
3.8
3.4
3.0
2.6
2.21.6 2.0 2.4
Age 20-39 yr
N o r m
a l
D i l a t
e d
Body Surface Area (m 2)
4.4
4.0
3.6
3.2
2.8
2.41.6 2.0 2.4
Age 40 yr
N o r m
a l
D i l a t e
d
A o r t
i c s i n u s e s
d i a m e t e r ( c m
)
Body Surface Area (m 2)
Valve Quantication
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Mitral stenosis
Mild Moderate Severe
71-139 140-219 220
10
1.6-2.0 1.0-1.5
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Mitral regurgitation (Primary Organic)
Mild Moderate Severe
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Tricuspid regurgitation
Mild Moderate Severe
Not dened 0.7
40
45 Soft/ Dense/ Dense/ parabolic variable triangular early
peaking
Normal Normal/dilated Usually dilated
Systolic Systolic Systolic dominance blunting reversal
VC width (cm)
EROA (mm2)
Regurgitant volume (mL)CW jet density/contour
RA/RV/IVC size
Hepatic vein ow
Valve Quantication
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Tricuspid stenosis
Severe
5
>60
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Pulmonary regurgitation
Jet width % of RVOT width
Pressure half-time
Doppler PR index(duration relative to diastolic cycle)
CF Doppler origin of PR jet.
Doppler timing of PR
Valve Quantication
Severe
>65%
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Chamber Quantication
Explanatory note & references These guidelines have been developed by theEducation Committee of the British Society ofEchocardiography. They have been adapted fromthe international recommendations and guidelinesreferenced below. Where there are differencesbetween published values, or there is a lack of clearevidence, recommended values have been developedon the basis of consensus opinion.
It is vital that echocardiographic measurements
are made using standard, correct techniques andthat all values are reported and interpreted inclinical context.
Chamber Quantication
Adapted from:Recommendations for Chamber Quantication: AReport from the American Society of EchocardiographysGuidelines and Standards Committee and the ChamberQuantication Writing Group, Developed in Conjunctionwith the European Association of Echocardiography, aBranch of the European Society of Cardiology.Lang RM et al. J Am Soc Echocardiogr 2005;18 :14401463
Right Ventricular FunctionAdapted from:Guidelines for the Echocardiographic Assessmentof the Right Heart in Adults: A Report from the ASEEndorsed by the EAE, and the CSE. Rudski, LG, et al. JAm Soc Echocardiogr 2010; 23 :685-713.
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L e f t v e n t r i c u
l a r s i z e , m a s s
& f u n c
t i o n
C h a m
b e r
Q u a n
t i c a
t i o n
N o r m
a l
M i l d
M o d
e r a
t e
S e v e r e
L V w a
l l t h i c k n e s s
I V S d / P W d ( c m )
L V d i m e n s i o n , w o m e n
L V I D d ( c m )
L V I D d / B S A ( c m / m 2 )
L V d i m e n s i o n , m e n
L V I D d ( c m )
L V I D d / B S A ( c m / m 2 )
L V v o
l u m e , w o m e n
L V d i a s t o l i c v o l u m e ( m L )
L V s y s t o l i c v o l u m
e ( m L )
L V v o
l u m e , m e n
L V d i a s t o l i c v o l u m e ( m L )
L V s y s t o l i c v o l u m
e ( m L )
L V v o
l u m e
i n d e x
L V d i a s t o
l i c v o
l u m e
/ B S A ( m L / m
2 )
L V s y s t o l i c v o l u m
e / B S A ( m L / m
2 )
L V f u n c t
i o n
F r a c t i o n a l s h o r t e n i n g ( % )
E j e c t i o n f r a c t i o n
( % )
L V m a s s
, w o m e n
2 D
L V m a s s ( g )
L V m a s s / B S A ( g / m 2 )
L V m a s s
, m e n 2
D
L V m a s s ( g )
L V m a s s / B S A ( g / m 2 )
0 . 6 - 1
. 2
1 . 3 - 1 . 5
1 . 6 - 1 . 9
2 . 0
3 . 9 - 5
. 3
5 . 4 - 5 . 7
5 . 8 - 6 . 1
6 . 2
2 . 4 - 3
. 2
3 . 3 - 3 . 4
3 . 5 - 3 . 7
3 . 8
4 . 2 - 5
. 9
6 . 0 - 6 . 3
6 . 4 - 6 . 8
6 . 9
2 . 2 - 3
. 1
3 . 2 - 3 . 4
3 . 5 - 3 . 6
3 . 7
5 6 - 1
0 4
1 0 5 - 1 1 7
1 1 8 - 1
3 0
1 3 1
1 9 - 4 9
5 0 - 5
9
6 0 - 6
9
7 0
6 7 - 1
5 5
1 5 6 - 1 7 8
1 7 9 - 2
0 1
2 0 2
2 2 - 5 8
5 9 - 7
0
7 1 - 8
2
8 3
3 5 - 7 5
7 6 - 8
6
8 7 - 9
6
9 7
1 2 - 3 0
3 1 - 3
6
3 7 - 4
2
4 3
2 5 - 4 3
2 0 - 2
4
1 5 - 1
9
< 1 5
5 5
4 5 - 5
4
3 6 - 4
4
3 5
6 6 - 1
5 0
1 5 1 - 1 7 1
1 7 2 - 1
9 3
> 1 9 3
4 4 - 8 8
8 9 - 1
0 0
1 0 1 - 1
1 2
> 1 1 2
9 6 - 2
0 0
2 0 1 - 2 2 7
2 2 8 - 2
5 4
> 2 5 4
5 0 - 1
0 2
1 0 3 - 1 1 6
1 1 7 - 1
3 0
> 1 3 0
E F b y B i p l a n e S i m p s o n s m e t h o d *
* P l e a s e s e e e x p l a n a t o r y n o t e
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Left ventricular diastolic function
Chamber Quantication
E/A, DT, s/d, e, LA volume
E/A, A 1-2DT 130-230
E/A >2**DT 1 E/e 1 E/e usually 8#
e reduced
LA
s/d 13
LA
s/d
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Left atrial size
LA size, womenLA diameter (cm) LA volume (mL)
LA size, menLA diameter (cm) LA volume (mL)
LA size, indexLA diameter (cm/m 2) LA volume (mL/m 2)
Normal Mild Moderate Severe
2.7-3.8 3.9-4.2 4.3-4.6 4.7 22-52 53-62 63-72 73
3.0-4.0 4.1-4.6 4.7-5.2 5.3 18-58 59-68 69-78 79
1.5-2.3 2.4-2.6 2.7-2.9 3.0 16-28 29-33 34-39 40
Chamber Quantication
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Chamber Quantication
Right ventricular size & function
RV dimensions (apical 4 chamber)Basal RV diameter (RVD1) (cm) Mid RV diameter (RVD2) (cm) RV wall thickness (mm)
RVOT diameters (parasternal SAX)RVOT at AV level (RVOT1) (cm)
RVOT at PV annulus (RVOT2) (cm)PA diameter (parasternal SAX)Main PA (PA1) (cm)
RV areaRV diastolic area (cm 2)
RV systolic area (cm 2)
RV functionFractional area change (%) TAPSE (mm)
Abnormal
>4.2>3.5
>5.0
>3.5
>2.7
>2.2
>25
>14
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British Society of Echocardiography Education CommitteeRichard Steeds (Chair), Gill Wharton (Lead Author), Katherine Collins, Jane Allen,Jane Graham, Richard Jones, Bushra Rana, Liam Ring, Navroz Masani
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