A reference chart is only useful if you also know where each number stops being reliable. These are the values in routine use, with the qualification attached to each, following current ASE and EACVI chamber quantification guidance.
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Left ventricle
| Measurement | Men | Women |
|---|---|---|
| End-diastolic diameter | 42–58 mm | 38–52 mm |
| End-systolic diameter | 25–40 mm | 22–35 mm |
| Septal and posterior wall thickness | 6–10 mm | 6–9 mm |
| LV mass index | ≤ 115 g/m² | ≤ 95 g/m² |
| End-diastolic volume index | 34–74 mL/m² | 29–61 mL/m² |
| Ejection fraction | 52–72% | 54–74% |
| Global longitudinal strain | more negative than −18% (absolute value ≥ 18%) | |
Ejection fraction bands: 41–51% mildly reduced, 30–40% moderately reduced, below 30% severely reduced. Strain falls before ejection fraction does, which is why it is the earlier signal in cardiotoxicity surveillance.
Left atrium
Left atrial volume index is the measurement that matters; anteroposterior diameter alone underestimates enlargement in a substantial minority. Normal is 16–34 mL/m². Above 34 is the threshold used in diastolic assessment, and left atrial enlargement in a patient in sinus rhythm is a marker of chronically raised filling pressure rather than an incidental finding.
Right heart
| Measurement | Normal |
|---|---|
| RV basal diameter | ≤ 41 mm |
| TAPSE | ≥ 17 mm |
| RV S′ (tissue Doppler) | ≥ 9.5 cm/s |
| RV fractional area change | ≥ 35% |
| Estimated RA pressure (IVC ≤ 21 mm, >50% collapse) | 3 mmHg |
| Peak tricuspid regurgitant velocity | ≤ 2.8 m/s |
Diastolic function
Four variables in the current algorithm: septal e′ below 7 cm/s or lateral e′ below 10 cm/s; average E/e′ above 14; peak tricuspid regurgitant velocity above 2.8 m/s; and left atrial volume index above 34 mL/m². With normal ejection fraction, fewer than half positive indicates normal function, more than half indicates raised filling pressure, and exactly half is indeterminate. That indeterminate category is common and should be reported as such rather than resolved by preference.
Valve severity thresholds
Aortic stenosis, severe: peak velocity ≥ 4.0 m/s, mean gradient ≥ 40 mmHg, valve area ≤ 1.0 cm² (≤ 0.6 cm²/m² indexed), dimensionless index ≤ 0.25.
Aortic regurgitation, severe: vena contracta > 6 mm, regurgitant volume ≥ 60 mL, regurgitant fraction ≥ 50%, pressure half-time < 200 ms, holodiastolic flow reversal in the descending aorta.
Mitral stenosis, severe: valve area ≤ 1.5 cm², mean gradient typically > 10 mmHg at normal heart rates.
Mitral regurgitation, severe: effective regurgitant orifice area ≥ 0.40 cm², regurgitant volume ≥ 60 mL, vena contracta ≥ 7 mm, systolic flow reversal in the pulmonary veins.
Tricuspid regurgitation, severe: vena contracta > 7 mm, effective orifice ≥ 0.40 cm², hepatic vein systolic flow reversal.
Where these numbers mislead
Low-flow low-gradient aortic stenosis produces a valve area in the severe range with a gradient that is not, and needs stroke volume index and often dobutamine stress to resolve. Valve area by continuity is dominated by the LVOT diameter because that term is squared — a one-millimetre error shifts the area by roughly a tenth, which is why the dimensionless index, which does not use the diameter, is the useful cross-check. Secondary mitral regurgitation is graded against different thresholds from primary disease. And every one of these numbers assumes an on-axis image; an off-axis measurement is not a borderline result, it is a wrong one.
Calculate valve area, stroke volume and cardiac output with the Academy’s cardiology calculators. Systematic teaching is in the diagnosis and imaging reading list and the echocardiography module of the course programme.