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Echokardiografické vyšetrenie

EN / SK

TECHmED.sk

Nové vyšetrenie
Ľavá komora
Diastolická funkcia ĽK
Pravá komora
Tlaky v PK
Kinetika a výpotok
Predsiene a VCI
Aorta
AoCh
MiCh
TrCh
PuCh
Záver vyšetrenia
Hodnoty
Projekcie

Echokardiografické vyšetrenie

TECHmED.sk

Nové
ĽK
Diastola ĽK
PK
Tlaky v PK
Kinetika
Predsiene
Aorta
AoCh
MiCh
TrCh
PuCh
Záver
Hodnoty
Projekcie

Normálne hodnoty

ĽK
Diastolická f ĽK
PK
Infarkt
Predsiene
Výpotok
VCI
Aorta
AoCh
MiCh
TrCh
PuCh

Ľavá komora

Left ventricle (Size)
Male Female
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
LVIDd (cm)

Left ventricular internal dimension at end-diastole

4,2 - 5,8 5,9 - 6,3 6,4 - 6,8 >6,8 3,8 - 5,2 5,3 - 5,6 5,7 - 6,1 >6,1
LVIDd (cm/m2)

Left ventricular internal dimension at end-diastole

2,2 - 3,0 3,1 - 3,3 3,4 - 3,6 >3,6 2,3 - 3,1 3,2 - 3,4 3,5 - 3,7 >3,7
LVIDs (cm)

Left ventricular internal dimension at end-systole

2,5 - 4,0 4,1 -  4,3 4,4 - 4,5 >4,5 2,2 - 3,5 3,6 - 3,8 3,9 - 4,1 >4,1
LVIDs (cm/m2)

Left ventricular internal dimension at end-systole

1,3 - 2,1 2,2 - 2,3 2,4 - 2,5 >2,5 1,3 - 2,1 2,2 - 2,3 2,4 - 2,6 >2,6
IVSd (cm)

Interventricular septum thickness at end-diastole

0,6 - 1,0 1,1 - 1,3 1,4 - 1,6 >1,6 0,6 - 0,9 1,0 - 1,2 1,3 - 1,5 >1,5
PWd (cm)

Left ventricular posterior wall thickness at end-diastole

0,6 - 1,0 1,1 - 1,3 1,4 - 1,6 >1,6 0,6 - 0,9 1,0 - 1,2 1,3 - 1,5 >1,5
RWT

Relative wall thickness

0,24 - 0,42 0,43 - 0,46 0,47 - 0,51 >0,52 0,22 - 0,42 0,43 - 0,47 0,48 - 0,52 >0,53
Left ventricle (Mass)
Male Female
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
LV mass (g)

Left ventricular mass

88 - 224 225 - 258 259 - 292 >292 67 - 162 163 - 186 187 - 210 >210
LV mass (g/m2)

Left ventricular mass

49 - 115 116 - 131 132 - 148 >148 43 - 95 96 - 108 109 - 121 >121
Left ventricle (Volume)
Male Female
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
LVEDV (ml)

Left ventricular end-diastole volume (Biplane)

62 - 150 151 - 174 175 - 200 >200 46 - 106 107 - 120 121 - 130 >130
LVEDV (ml/m2)

Left ventricular end-diastole volume (Biplane)

34 - 74 75 - 89 90 - 100 >100 29 - 61 62 - 70 71 - 80 >80
LVESV (ml)

Left ventricular end-systole volume (Biplane)

21 - 61 62 - 73 74 - 85 >85 14 - 42 43 - 55 56 - 67 >67
LVESV (ml/m2)

Left ventricular end-systole volume (Biplane)

11 - 31 32 - 38 39 - 45 >45 8 - 24 25 - 32 33 - 40 >40
Left ventricle (Ejection fraction)
Male Female
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
LV EF (%)

Left ventricular ejection fraction (Biplane)

52 - 72 41 - 51 30 - 40 <30 54 - 74 41 - 53 30 - 40 <30
Left ventricle (Geometry)
LV mass(g/m2)

Left ventricular mass

RWT

Relative wall thickness

Normal left ventricle ≤115 (Male)≤95 (Female) <0,42
Concentric hypertrophy >115 (Male)>95 (Female) >0,42
Eccentric hypertrophy >115 (Male)>95 (Female) <0,42
Concentric remodeling ≤115 (Male)≤95 (Female) >0,42

Description of LV geometry, using at the minimum the four categories of normal geometry, concentric remodelling, and concentric and eccentric hypertrophy, should be a standard component of the echocardiography report.

Left ventricle (Geometry)
LVEDV(ml/m2)

Left ventricular end-
diastole volume (Biplane)

LV mass(g/m2)

Left ventricular mass

RWT

Relative wall thickness

Normal left ventricle ≤75 ≤115 (Male)≤95 (Female) 0,32-0,42
Physiological hypertrophy >75 >115 (Male)>95 (Female) 0,32-0,42
Concentric remodeling ≤75 ≤115 (Male)≤95 (Female) >0,42
Eccentric remodelling >75 ≤115 (Male)≤95 (Female) <0,32
Concentric hypertrophy ≤75 >115 (Male)>95 (Female) >0,42
Mixed hypertrophy >75 >115 (Male)>95 (Female) >0,42
Dilated hypertrophy >75 >115 (Male)>95 (Female) 0,32-0,42
Eccentric hypertrophy >75 >115 (Male)>95 (Female) <0,32
Echocardiography: LV geometry classified according to LV mass, LV volume, and RWT
  • The red horizontal line separates LV hypertrophy from normal LV mass.
  • The black vertical line separates dilated from nondilated ventricles.
  • The two oblique blue lines delimit the upper (0.42) and lower (0.32) limit of normal RWT.
  • This leads to eight categories of ventricles.
  • The green ellipse indicates the area of normal ventricles including physiological LV enlargement.

Diastolická funkcia ľavej komory

Echocardiography: Diastolic dysfunction grading (Algorithm)
  1. LAP indeterminate if only 1 of 3 parameters available. Pulmonary vein S/D ratio <1 applicable to conclude elevated LAP in patients
    with depressed LV EF.
Assessment of LV filling pressures in special populations
Disease Echocardiographic measurements and cutoff values
Atrial fibrillation Peak acceleration rate of mitral E velocity (≥1,900 cm/sec 2)
IVRT (≤65 msec)
DT of pulmonary venous diastolic velocity (≤220 msec)
E/Vp ratio (≥1.4)
Septal E/e´ ratio (≥11)
Sinus tachycardia Mitral inflow pattern with predominant early LV filling in patients with EFs <50%
IVRT ≤70 msec is specific (79%)
Pulmonary vein systolic filling fraction ≤40% is specific (88%)
Average E/e´ >14 (this cutoff has highest specificity but low sensitivity)
When E and A velocities are partially or completely fused, the presence of a compensatory period after premature beats often leads to separation of E and A velocities which can be used for assessment of diastolic function
Hypertrophic cardiomyopathy Average E/e´ (>14)
Ar-A (≥30 msec)
TR peak velocity (>2.8 m/sec)
LA volume (>34 mL/m2).
Restrictive cardiomyopathy DT (<140 msec)
Mitral E/A (>2.5)
IVRT (<50 msec has high specificity)
Average E/e´ (>14)
Noncardiac pulmonary hypertension Lateral E/e´ can be applied to determine whether a cardiac etiology is the underlying reason for the increased pulmonary artery pressures
When cardiac etiology is present, lateral E/e´ is >13, whereas in patients with pulmonary hypertension due to a noncardiac etiology, lateral E/e´ is <8
Mitral stenosis IVRT (<60 msec has high specificity)
IVRT/TE-e´ (<4.2)
Mitral A velocity (>1.5 m/sec)
Mitral regurgitation Ar-A (≥30 msec)
IVRT (<60 msec has high specificity)
IVRT/TE-e´ (<5.6) may be applied for the prediction of LV filling pressures in patients with MR and normal EFs
Average E/e´ (>14) may be considered only in patients with depressed EFs
Echocardiography: Hypertrophic cardiomyopathy diastolic dysfunction Echocardiography: Restrictive cardiomyopathy diastolic dysfunction Echocardiography: Valvular heart disease diastolic dysfunction Echocardiography: Heart transplant, AV block, atrial fibrillation diastolic dysfunction

Pravá komora

Right ventricle (Size)
RVD1basal

Right ventricular basal diameter at end-diastole

25 - 41mm
RVD2mid

Right ventricular mid diameter at end-diastole

19 - 35mm
RVD3long

Right ventricular longitudinal diameter at end-diastole

59 - 83mm
RVOTprox(PLAX)

Right ventricular outflow tract at proximal (PLAX)

20 - 30mm
RVOTprox(PSAX)

Right ventricular outflow tract at proximal (PSAX)

21 - 35mm
RVOTdistal(PSAX)

Right ventricular outflow tract at distal (PSAX)

17 - 27mm
PAdiameter

Main pulmonary artery diameter

15 - 25mm
RVWT

Right ventricular wall thickness

1 - 5mm
Right ventricle (Area, Volume)
Male Female
RV EDA (cm2)

Right ventricular end-diastolic area

10 - 24 8 - 20
RV EDA (cm2/m2)

Right ventricular end-diastolic area

5 - 12,6 4,5 - 11,5
RV ESA (cm2)

Right ventricular end-systolic area

3 - 15 3 - 11
RV ESA (cm2/m2)

Right ventricular end-systolic area

2 - 7,4 1,6 - 6,4
RV EDV (ml/m2)

Right ventricular end-diastolic volume

35 - 87 32 - 74
RV ESV (ml/m2)

Right ventricular end-systolic volume

10 - 44 8 - 36
Right ventricle (Function)
Variable Abnormal
TAPSE

Tricuspid annular plane systolic excursion

<17mm
S’ WavepulsedTDI

Peak systolic velocity tricuspid annulus (Pulsed TDI)

<9,5cm/s
S’ WavecolorTDI

Peak systolic velocity tricuspid annulus (Color TDI)

<6cm/s
FAC

Fractional Area Change

<35%
RV EF

Right ventricular ejection fraction

<45%
RIMPTDI

Right Ventricular Index of Myocardial Performance (TDI)

>0,54
RIMPPWd

Right Ventricular Index of Myocardial Performance (PWd)

>0,43
IVARV

Myocardial acceleration during isovolumic contraction

<1,1m/s2
PVR

Pulmonary vascular ressistance

>3WU
RV dP/dt

Rate of rise of right ventricle pressure

<400mmHg/s
E/ATrV

Tricuspid valve E / A wave ratio

<0,8
>2
DT TrV

Tricuspid valve deceleration time

<119ms
>242ms
e´ waveTrV

eak velocity in early diastole of tricuspid annulus (TDI)

<7,8cm/s
e´/a´TrV

Tricuspid valve e´ / a´ ratio (TDI)

<0,52
E/e´TrV

Tricuspid valve E / e´ ratio

>6
PAAT

Pulmonary artery acceleration time

<100ms
Right ventricle (Pressure)
Variable Abnormal
RVSP(SPAP)

Right ventricular systolic pressure

>35mmHg
mPAP

Mean pulmonar arterial pressure

>25mmHg
PADP

Pulmonary artery diastolic pressure

>15mmHg
Right ventricle (Pressure overload)
Variable Abnormal
RVOTprox(PLAX)

Right ventricular outflow tract at proximal (PLAX)

>30mm
Basal RV/LV

Basal right/left ventricle ratio

>1
D septum

D shaped septum

Yes
IVCdiameter

Inferior vena cava diameter

>2,1cm
IVCcollaps

Inferior vena cava collapsibility

<50%
60/60 sign

60/60 Echo sign

Yes
McConnel´s sign

Mid wall hypokinesia and apical hyperkinesia

Yes
Trombus RV

Right heart mobile trombus

Yes
TAPSE

Tricuspid annular plane systolic excursion

<16mm
S’ wavepulsedTDI

Peak systolic velocity tricuspid annulus (Pulsed TDI)

<9,5cm/s

Infarkt myokardu a segmenty

Distal septum infarct (Echocardiography segments)

Distal septum infarct

  • LAD (distal, mid., prox.)
  • Low remodeling risk
  • A4C, A2C, A3C (Echo views)
Supraapical infarct (Echocardiography segments)

Supraapical infarct

  • LAD (distal, mid., prox.)
  • Small supraapical aneurysm
  • Low remodeling risk

Supraapical and distal septal infarcts can also occur in proximal LAD occlusion after rapid reperfusion.

Proximal LAD type AMI (Echocardiography segments)

Proximal LAD type AMI

  • LAD (before 1st septal branch, left main)
  • Always remodeling
  • Poor prognosis
Small basal inferior infarct (Echocardiography segments)

Small basal inferior infarct

  • RCA
  • Difficult region to interpret
  • Low remodeling risk
Inferior Infarct (Echocardiography segments)

Inferior Infarct

  • RCA
  • Low-moderate remodeling risk
Infero Posterior Infarct (Echocardiography segments)

Infero-Posterior Infarct

  • RCA (dominant) or Cx (large, prox.)
  • Moderate remodeling risk
  • Inferolateral (also called posterior)
Postero lateral Infarct (Echocardiography segments)

Posterolateral Infarct

  • CX, RCA
  • Moderate remodeling risk
  • Inferolateral (also called posterior)
Infero Posterior Lateral Infarct (Echocardiography segments)

Infero-Posterior-Lateral Infarct

  • Dominant RCA, CX (large, prox.)
  • High remodeling risk
  • Inferolateral (also called posterior)

Inferior/ posterior/ postero-lateral infarcts pose an elevated risk for restrictive MR!

Lateral Infarct (Echocardiography segments)

Lateral Infarct

  • CX, LAD (diagonal branch, difficult to interpret)
  • Low remodeling risk
  • When assessing the patterns of myocardial infarction, always consider the possibility of multiple/sequential infarcts!

Echocardiography: 17 segments of left ventricle, coronary artery territories
Coronary artery territories and right ventricular RV segments

Predsiene

Left atrium (Size)
Female Male
LA AP (cm)

Left atrium anterior-posterior dimension

2,7 - 3,8 3,0 - 4,0
LA AP (cm/m2)

Left atrium anterior-posterior dimension

1,5 - 2,3 1,5 - 2,3
Left atrium (Volume)
Male Female
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
Normal
range
Mildly
abnormal
Moderately
abnormal
Severely
abnormal
LA volume (ml/m2)

Left atrial volume (Biplane)

16 - 34 35 - 41 42 - 48 >48 16 - 34 35 - 41 42 - 48 >48
Right atrium (Size)
Variable Abnormal
RA major (mm)

Right atrium major axis dimension

>53
RA minor (mm)

Right atrium minor axis dimension

>44
RA area (cm2)

Right atrial area

>18
Right atrium (Size, Volume)
Male Female
RA major (cm/m2)

Right atrium major axis dimension

2,4 ±0,3 2,5 ±0,3
RA minor (cm/m2)

Right atrium minor axis dimension

1,9 ±0,3 1,9 ±0,3
RA volume (ml/m2)

Right atrium volume (Single plane)

25 ±7 21 ±6
Right atrium (Pressure)
Normal
3mmHg
(0 - 5mmHg)
Intermediate
8mmHg
(5 - 10mmHg)
Intermediate
8mmHg
(5 - 10mmHg)
High
15mmHg
(10 - 20mmHg)
IVCdiameter

Inferior vena cava diameter

<2,1cm <2,1cm >2,1cm >2,1cm
IVCcollaps

Inferior vena cava collapsibility

>50% <50% >50% <50%

Perikardiálny výpotok

Pericardial effusion (Quantification)
Small <1mm 300ml
Moderate 10 - 20mm 500 - 700ml
Large >20mm >700ml
Very large >30mm Compression


Vena cava inferior

Inferior vena cava (Size)
Variable Abnormal
IVCdiameter

Inferior vena cava diameter

>2,1cm

Aorta

Aorta (Size)
Variable Abnormal
AoA

Aortic annulus diameter

20 - 31mm
AoSV

Aortic sinuses of valsalva diameter

29 - 45mm
AoSTJ

Aortic sinotubular junction diameter

22 - 36mm
AoPxA

Proximal ascending aorta diameter

22 - 36mm
AoArch

Aortic arch diameter

22 - 36mm
AoDesc

Descending aorta diameter

20 - 30mm

Aortálna chlopňa

Aortic stenosis
Aortic sclerosis Mild Moderate Severe
Vmax AoV (m/s)

Aortic valve maximum velocity

≤2,5 2,6 - 2,9 3,0 - 4,0 ≥4,0
meanPG AoV (mmHg)

Aortic valve mean pressure gradient

<20 20 - 40 ≥40
AVA (cm2)

Aortic valve area (continuity equation)

>1,5 1,0 - 1,5 <1,0
AVA (cm2/m2)

Aortic valve area (continuity equation)

>0,85 0,60 - 0,85 <0,60
Velocity ratio

Aortic valve velocity ratio (Dimensionless index)

>0,5 0,25 - 0,5 <0,25
Aortic regurgitation
Mild Moderate Severe
Structural parameters
Aortic leaflets Normal or abnormal Normal or abnormal Abnormal/flail, or wide coaptation defect
Left ventricle (Size) Normal1

(LVEDV ≤150ml male, ≤106ml female)

Normal or mild dilated Usually dilated2

(LVEDV >150ml male, >106ml female)

Qualitative doppler
RegJetwidht

Regurgitation jet witdh

Small in central jets

(Width in LVOT <25%)

Intermediate Large in central jets; variable in eccentric jets

(Width in LVOT >65%)

Flow convergence (PISAr) None or very small

(<0,3cm)

Intermediate Large

(≥1cm)

RegJetdensity

Regurgitant jet density
(CW doppler)

Incomplete or faint Dense Dense
PHTRegJet3

Pressure half time of regurgitant jet

Incomplete or faint Slow

(>500ms)

Medium

(200-500ms)

Steep

<200ms

Diastolic reversal flow

in descending aorta (PW doppler)

Brief, early diastolic reversal Intermediate Prominent holodiastolic reversal
Semiquantitative parameters4
VCW (cm)

Vena contracta width

<0,3 0,3 - 0,6 >0,6
RegJetwidth in LVOT (%)

Regurgitation jet width in LVOT (centrel jets)

<25 25-45 46-64 ≥65
CSARegJet in CSA LVOT (%)

Regurgitation jet CSA in LVOT CSA (centrel jets)

<5 5-20 21-59 ≥60
Quantitative parameters4
Grade I Grade II Grade III Grade IV
EROA (cm2)

Effective regurgitant orifice area

<0,1 0,1 - 0,19 0,2 - 0,29 ≥0,3
RegVol (ml)

Regurgitant volume of aortic regurgitation

<30 30 - 44 45 - 59 ≥60
RF (%)

Regurgitant fraction of aortic valve

<30 30 - 39 40 - 49 ≥50
  • Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.
  1. Unless there are other reasons for LV dilation.
  2. Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
  3. PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
  4. Quantitative parameters can subclassify the moderate regurgitation group.
Echocardiography: Aortic regurgitation quantification (Algorithm)

Mitrálna chlopňa

Mitral stenosis
Mild Moderate Severe
MVA (cm2)*

Mitral valve area

>1,5 1 - 1,5 <1
meanPG MV (mmHg)

Mitral valve mean pressure gradient

<5 5 - 10 >10
RVSP(SPAP) (mmHg)

Right ventricular systolic pressure

<30 30 - 50 >50

* Specific findings

Chronic mitral regurgitation
Mild Moderate Severe
Structural
Mitral valve morphology None or mild leaflet abnormality

(e.g., mild thickening, calcifications or prolapse, mild tenting)

Moderate leaflet abnormality or moderate tenting Severe valve lesions

(primary: flail leaflet, ruptured papillary muscle, severe retraction, large perforation; secondary: severe tenting, poor leaflet coaptation)

Left ventricle (Size)1 Usually normal

(LVEDV ≤150ml male, ≤106ml female)

Normal or mild dilated Dilated2

(LVEDV >150ml male, >106ml female)

Left atrium (Size)1 Usually normal

(LA volume ≤34ml/m2)

Normal or mild dilated Dilated2
Qualitative doppler
RegJetarea

Regurgitation jet area.
(Nyquist limit 50-70cm/s)

Small, central, narrow, often brief

(RegJet/LA area <20%)

Variable Large central jet

(RegJet/LA area >50%) or eccentric wall-impinging jet of variable size

Flow convergence (PISAr)

(Nyquist limit 30-40cm/s)

Not visible, transient or small

(PISAr <0,3cm)

Intermediate in size and duration Large throughout systole

(PISAr ≥1cm)

Regurgitant jet

(CW doppler)

Faint/ partial/ parabolic Dense but partial or parabolic Holosystolic/ dense/ triangular
Semiquantitative
VCW (cm)

Vena contracta width

<0,3cm 0,3 - 0,7cm >0,7cm (>0,8cm)3
Pulmonary vein flow4 Systolic dominance (may be blunted in LV dysfunction or AF) Normal or systolic blunting Minimal to no systolic flow/ systolic flow reversal
Mitral inflow5 A wave dominant

(A wave > E wave)

Variable E wave dominant

(E wave >1,2m/s)

Quantitative6
Grade I Grade II Grade III Grade IV
EROA (cm2)

Effective regurgitant orifice area

<0,2 0,2 - 0,3 0,3 - 0,39 ≥0,4
RegVol (ml)

Regurgitant volume of mitral regurgitation

<30 30 - 44 45 - 59 ≥60
RF (%)

Regurgitant fraction of mitral valve

<30 30 - 39 40 - 49 ≥50
  • Bolded qualitative and semiquantitative signs are considered specific for their MR grade.
  • All parameters have limitations, and an integrated approach must be used that weighs the strength of each echocardiographic measurement. All signs and measures should be interpreted in an individualized manner that accounts for body size, sex, and all other patient characteristics.
  1. This pertains mostly to patients with primary
  2. LV and LA can be within the ‘‘normal’’ range for patients with acute severe MR or with chronic severe MR who have small body size, particularly women, or with small LV size preceding the occurrence of MR.
  3. For average between apical two- and four-chamber views (Biplane).
  4. Influenced by many other factors (LV diastolic function, atrial fibrillation, LA pressure).
  5. Most valid in patients >50 years old and is influenced by other causes of elevated LA pressure.
  6. Discrepancies among EROA, RF, and RegVol may arise in the setting of low or high flow states. Quantitative parameters can help subclassify the moderate regurgitation group.
Echocardiography: mitral regurgitation echo severity (Algorithm)

Trikuspidálna chlopňa

Tricuspid stenosis
Variable Abnormal
meanPG TrV*

Mean pressure gradient tricuspidal valve

≥5mmHg
VTI TrV*

Velocity time integral of tricuspid valve (inflow)

>60cm
PHT TrV*

Pressure half time of tricuspidal valve

≥190ms
TrVA*

Tricuspid valve area (continuity equation)

≤1cm2
RA major

Right atrium major axis dimension

>50mm
IVCdiameter

Inferior vena cava diameter

>2,1cm

* Specific findings

Chronic tricuspid regurgitation
Mild Moderate Severe
Structural
Tricuspid valve morphology Normal or mildly abnormal leaflets Moderately abnormal leaflets Severe valve lesions

(e.g., flail leaflet, severe retraction, large perforation)

Right atrium (Size) Usually normal

(RA major <45mm)

Normal or mild dilatation Usually dilated1

(RA major >45mm)

Right ventricle (Size) Usually normal

(RVD1basal <41mm)

Normal or mild dilatation Usually dilated1

(RVD1basal >41mm)

IVCdiameter

Inferior vena cava diameter

Normal

(IVCdiameter <2cm)

Normal or mildly dilated

(IVCdiameter 2,1 - 2,5cm)

Dilated

(IVCdiameter >2,5cm)

Qualitative doppler
RegJetarea

Regurgitation jet area.
(Nyquist limit 50-70cm/s)

Small, narrow, central

(RegJet/RA area <20%)

Moderate central Large central jet

(RegJet/RA area >50%) or eccentric wall-impinging jet of variable size

Flow convergence (PISAr)

(Nyquist limit 30-40cm/s)

Not visible, transient or small

(PISAr <0,3cm)

Intermediate in size and duration Large throughout systole

(PISAr ≥1cm)

Regurgitant jet

(CW doppler)

Faint/ partial/ parabolic Dense but partial or parabolic Dense, often triangular
Semiquantitative
RegJetarea (cm2)

Regurgitation jet area
(Nyquist limit 50-70cm/s)

Not defined Not defined >10
VCW (cm)

Vena contracta width
(Nyquist limit 50-70cm/s)

<0,3 0,3 - 0,69 ≥0,7
PISAr (cm)

(Nyquist limit 30-40cm/s)

≤0,5 0,6 - 0,9 >0,9
Hepatic vein flow2 Systolic dominance Systolic blunting Systolic flow reversal
Tricuspid inflow2 A wave dominant

(A wave > E wave)

Variable E wave

(E wave >1m/s)

Quantitative
EROA (cm2)

Effective regurgitant orifice area

<0,2 0,2 - 0,393 ≥0,4
RegVol (ml)

Regurgitant volume of tricuspid regurgitation

<30 30 - 443 ≥45
  • Bolded signs are considered specific for their tricuspid regurgitation grade.
  1. RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
  2. Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
  3. There are little data to support further separation of these values.
Echocardiography: tricuspid regurgitation severity echo

Pulmonálna chlopňa

Pulmonary stenosis
Mild Moderate Severe
Vmax PV (m/s)

Maximal (peak) velocity pulmonary valve

<3 3 - 4 >4
maxPG PV (mmHg)

Pulmonary valve maximal pressure gradient

<36 36 - 64 >64
Pulmonary regurgitation
Mild Moderate Severe
Pulmonic valve Normal Normal or abnormal Abnormal and may not be visible
Right ventricle (Size) Normal1

(RVD1basal <41mm)

Normal or dilated Dilated2

(RVD1basal >41mm)

RegJetlength

Regurgitant jet length
(Nyquist limit 50-70cm/s)

Thin with a narrow origin

(usually <10 mm in length)

Intermediate Broad origin; variable depth of penetration
RatioRegJet/PV

Ratio regurgitant jet width / pulmonary valve annulus

>70%3
RegJetdensity

Regurgitant jet density
(CW doppler)

Soft Dense Dense; early termination of diastolic flow
DTRegJet

Deceleration time of pulmonary regurgitant jet

Short4

(<260ms)

PHTRegJet

Pressure half time of pulmonary regurgitant jet

<100ms5
PR index6

Pulmonory regurgitation index

<0,77 <0,77
PAreversal flow

Reversal flow in the branch pulmonary artery

Yes
PV VTI / LVOT VTI7

Pulmonic systolic VTI compered to LVOT VTI

Slightly increased Intermediate Greatly increased
RF8

Regurgitant fraction of pulmonary valve

<20% 20-40% >40%
  1. Unless there are other reasons for RV enlargement.
  2. Exception: acute PR.
  3. Identifies a CMR-derived PR fraction >40%.
  4. Steep deceleration is not specific for severe PR.
  5. Not reliable in the presence of high RV end diastolic pressure.
  6. Defined as the duration of the PR signal divided by the total duration of diastole, with this cutoff identifying a CMR-derived PR fraction > 25%.
  7. Cutoff values for regurgitant volume and fraction are not well validated.
  8. RF data primarily derived from CMR with limited application with echocardiography.
Echocardiography: pulmonary regurgitation severity

Zdroje:

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)

Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

Echocardiography in aortic diseases: EAE recommendations for clinical practice (2010)

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

ESSENTIAL ECHOCARDIOGRAPHY A Companion to Braunwald’s Heart Disease

Coronary Artery Territories (Echocardiography Illustrated Book 4)