Cardiac Chamber quantification by echocardiography.pptx

ASE guideline on how and whre to measure cardiac chambers inclunding left atrium, left ventricle, right atriam, right ventricle and aorta.
quantify heart function. measures of function of the cardiac left chambers and cardiac right chambers. Determining the GLS

1. Cardiac Chamber Quantification by Echocardiography in Adults Antonios Zakharia M.D. Cardiovascular Disease Springfield Memorial Hospital

2. LV Size: Linear Measurements Calipers should be positioned on the interface between the myocardial wall and cavity and the interface between the wall and the pericardium. Measure LVIDd at end diastole (the 1st frame after mitral valve closure or the frame with the largest LV dimensions/volume) immediately below the level of the mitral valve leaflet tips.  Measure LVIDs at end systole: 1st f rame after aortic valve closure or the smallest LV dimension/volume 

3. Standard LV Measurement Parameters  7/23/2025 4

4. LV mass and relative wall thickness LV mass = 0.8 x (1.04x [(IVS+LVID+PWT)^3-LVID^3] + 0.6 grams  LV mass/BSA = LV mass index RWT= (2x posterior wall thickness)/(LVIDD)  There is a 2D method formula to calculate LV mass and wall thickness that is infrequently used in most clinical labs (see full Guideline statement for details) 

5. Normal Ranges and Severity Cutoff Values for LV Wall Thickness and Mass Using Linear Method  7/23/2025 6

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7. LV size: Volume measurements Preferred technique is Biplane Method of Discs (modified Simpson’s rule) Measured from the 4- and 2-chamber views (preferably an LV focused view) tracing the endocardial – blood pool interface (between the compacted myocardium and the cavity) at end-diastole and end-systole on images with clear endocardial border definition.  Papillary muscles should be excluded from the cavity tracing.  Avoid foreshortening.  The contour is closed by connecting the two opposite sections of the MV ring with a straight line, and the LV length is the bisector between this line and the apical point.  Contrast agents should be used when two or more contiguous LV endocardial segments are poorly visualized.

8. 7/23/2025 9 Advantages Corrects for shape distortions Less geometrical assumptions compared with linear dimensions Pitfalls Apex frequently foreshortened Endoocardial dropout Blind to shape distortions not visualized in the apical 2- and 4-chamber planes

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10. LV Size and function by 3D 7/23/2025 11

11. LV size and function vary by age, gender and ethnicity 7/23/2025 12

12. LV function assessment Fractional Shortening (use is discouraged) FS = LVIDD – LVIDS / LVIDD (normal > 25%)  Derived from M-mode or linear 2D measurements  Ejection Fraction (EF) is the predominant method for assessing global systolic function LVEF = LVEDV – LVESV / LVEDV  Volumes derived from linear measurements should NOT be used.  Global Longitudinal Strain 7/23/2025 13

13. Normal range and severity partitions A normal ejection fraction is 52-72% for men and 54-74% for women.  7/23/2025 14

14. Global Longitudinal Strain GLS (%) = ( ML s - ML d )/ ML d   Peak GLS is a negative number   Measured in the 3 standard apical views HR should not vary more than 5bpm  Generally, peak GLS of -20% is considered normal. 7/23/2025 15

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16. RV size and function using 2DE In order to assess RV size and function it is important to use all available views . The essential views for imaging and assessment of the RV are:   Left parasternal long-axis view (PLAX)  Left parasternal short-axis view (PSAX)  Left parasternal RV inflow view  Apical 4-chamber view  Focused apical 4-chamber RV view  Modified apical 4-chamber view  Subcostal views  7/23/2025 17

17. RV size All chamber measurements should be made inner-edge to inner-edge. The report should include both qualitative and quantitative parameters . Values are not indexed to gender, BSA, or height.  7/23/2025 18

18. RV linear dimensions are dependent on probe rotation and different RV views. 7/23/2025 19

19. RV size An RV diameter of >41mm at the base and >35mm at the mid-level is abnormal.  RV wall thickness should be measured by 2D or M-mode at end-diastole, preferably from the subcostal view . A thickness of >5mm is abnormal.  7/23/2025 20

20. 7/23/2025 21 2-3.3 cm 1.7 - 2.7 cm 2.1-3.7 cm ≤3.5cm ≤4.1cm

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22. RV Volume using 3DE  7/23/2025 23

23. RV function RV systolic function should be assessed by at least one or a combination of the following recommended parameters :  TAPSE (Tricuspid Annular Plane Systolic Excursion) DTI-Derived Tricuspid Lateral Annular Systolic Velocity S’ FAC (fractional area change) RV longitudinal strain  3D EF  Right Index of Myocardial Performance (RIMP or MPI)  7/23/2025 24

24. TAPSE and DTI 7/23/2025 25 Affected by apical translation Normal ≥17 Normal ≥9.5

25. Factional Area Change FAC reflects both longitudinal and radial components of RV contraction. Correlates with CMR RV EF. It does not include the contribution of RV outflow tract to overall systolic function.  Normal FAC is ≥35% 7/23/2025 26

26. RV Strain 7/23/2025 27 RV longitudinal strain is less confounded by overall heart motion, but depends on RV loading conditions as well as RV size and shape. RV longitudinal strain should be measured in the RV-focused view.  Normal is –20%

27. RV EF by 3DE 7/23/2025 28

28. RIMP or MPI Used to assess global RV function Obtained using pulse doppler or DTI RIMP = (TCO – ET)/ET               = (IVCT+IVRT)/ET Normal value depends on the method. 7/23/2025 29

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31. LA Size 7/24/2025 32

32. LA size normal ranges and Cutoffs 7/24/2025 33

33. RA size Obtain RA area and volume in dedicated right heart view (4 chamber view) Normal RA Area ≤18 cm2 RA volumes are25±7 mL/m2 in men and 21 ±6 mL/m2 in women. 7/24/2025 34

34. Aortic measurements Aortic measurements should be made at the following sites:  Aortic valve annulus Sinuses of Valsalva, Sino-tubular junction Proximal ascending aorta 7/24/2025 35

35. Aortic annulus Measurement should be performed between the hinge points of the aortic valve leaflets from inner edge to inner edge.  Calcium protuberances should be considered as part of the lumen, not of the aortic wall, and therefore excluded from the diameter measurement  7/24/2025 36

36. Aortic root and ascending aorta Measure leading edge to leading edge convention  Measurements should be made in the view that depicts the maximum aortic diameter perpendicular to the long axis of the aorta and at end-diastole Asymmetric closure line of the aortic is an indication that the cross-section is not encompassing the largest root diameter.  7/24/2025 37

37. IVC IVC<2.1 cm w/ >50% collapse with sniff ➔ estimated RAP 3mmHg IVC>2.1 w/ <50% collapse with sniff ➔ estimated RAP 15mmHg Anything else ➔ estimated 8mmHg 7/24/2025 38

38. References Lang, Roberto M., et al. “Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.” Journal of the American Society of Echocardiography , vol. 28, no. 1, 2015, pp. 1–39.e14. https://doi.org/10.1016/j.echo.2014.10.003 ASE Workflow and Lab Management Taskforce. “The American Society of Echocardiography Recommendations for Cardiac Chamber Quantification in Adults: A Quick Reference Guide from the ASE Workflow and Lab Management Task Force.” July 2018. American Society of Echocardiography, http://asecho.org/wordpress/wp-content/uploads/2016/02/2015_ChamberQuantificationREV.pdf

39. THANK YOU 7/24/2025 40