LA length and trasverse major and minor axis were measured from the apical four-chamber view. The 2D RV outflow tract diameters were measured from the parasternal long-axis (proximal) and the short-axis views (proximal and distal) at the level of the aortic valve. The RV fractional area change (FAC) was calculated by the equation 100 × (end-diastolic area – end-systolic area)/end-diastolic area. Assessment of right ventricular (RV) size was performed by measuring RV end-diastolic and end-systolic areas as well as end-diastolic mid- and basal-cavity diameters from the apical four-chamber view ( Figure Figure3 3). The LV mass was calculated from linear measurements obtained from parasternal views. LV ejection fraction was then calculated from the respective 2D LV volumes. LV end-diastolic and end-systolic volumes were measured using the biplane method of discs' summation (modified Simpson's rule) using two-dimensional (2D) images from both the apical four- and two-chamber views ( Figure Figure2 2). ![]() Interventricular septal and posterior wall thicknesses at end-diastole and LV internal dimension at both end-diastole and end-systole were measured from the parasternal long-axis acoustic window. The LV outflow tract (LVOT) diameters were measured at the aortic valve annulus (distal) and 0.5–1 cm below the aortic cups (proximal) from a zoomed parasternal long-axis acoustic window ( Figure Figure1 1). All three standard left ventricular (LV) apical views (four-, two-, three-chamber views) were acquired avoiding LV foreshortening. A minimum of three cardiac cycles were recorded for analysis. 5, 6 All Doppler-echocardiographic images were recorded in a digital raw-data format (native DICOM format) and centralized, after anonymization, at the EACVI Central Core Laboratory at the University of Liège, Belgium. In this study, we report the reference ranges for all cardiac chamber sizes taking into account gender and age.Ī comprehensive echocardiographic examination was performed using state-of-the-art echocardiographic ultrasound systems (GE Vivid E9, Vingmed Ultrasound, Horten, Norway, and/or iE33, Philips Medical Systems, Andover, MA, USA) following recommended protocols approved by EACVI. 5 The NORRE study provides a set of normal contemporary echocardiographic values obtained from a large cohort of healthy subjects over a wide range of ages acquired using recommended echocardiographic approaches. 2– 4 The Normal Reference Ranges for Echocardiography (NORRE) study is the first European large multi-centre study involving accredited echocardiography laboratories of the European Association of Cardiovascular Imaging (EACVI). 1 Currently, available echocardiographic reference values are mostly based on cross-sectional studies including a mixture of published and unpublished reports or selected samples using a variety of mostly dated echocardiographic techniques. ![]() ![]() However, as for all imaging modalities the interpretation depends upon the availability of robust reference limits that define ‘normalcy’. In fact, transthoracic echocardiography has become the standard imaging modality for the assessment of cardiovascular anatomy, function, and physiology in clinical practice. Thanks to its versatility, the indications for echocardiography have progressively expanded.
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