Cardiac Chamber Quantification
The 2015 ASE/EACVI guidelines provide updated normal values for all four cardiac chambers, including 3D echocardiography and myocardial deformation, based on large multicenter databases. This card covers key measurements, normal reference ranges, and severity cutoffs.
📊 At-a-Glance Normal Values
| Parameter | Men — Normal | Women — Normal | Abnormality Threshold |
|---|---|---|---|
| Left Ventricle | |||
| LV diastolic diameter (cm) | 4.2 – 5.8 | 3.8 – 5.2 | >5.8 (M) / >5.2 (F) |
| LV EDV/BSA (mL/m²) | 34 – 74 | 29 – 61 | >74 (M) / >61 (F) |
| LV EF — biplane (%) | 52 – 72 | 54 – 74 | <52 (M) / <54 (F) |
| LV mass/BSA — linear (g/m²) | 49 – 115 | 43 – 95 | >115 (M) / >95 (F) |
| Relative wall thickness | 0.22 – 0.42 | >0.42 = concentric | |
| GLS (speckle tracking) | ≈ −20% | <−20% (less negative) = abnormal | |
Right Ventricle — 2015 ASE Reference Values Updated 2025 guidelines → | |||
| RV basal diameter (mm) | 25 – 41 | >41 | |
| TAPSE (mm) | ≥17 | <17 | |
| RV FAC (%) | ≥35 | <35 | |
| RV 3D EF (%) | ≥45 | <45 | |
| Atria | |||
| LA volume/BSA (mL/m²) | 16 – 34 | Mildly: 35–41; Mod: 42–48; Severe: >48 | |
| RA area (cm²) | ≤18 | >18 | |
| Aortic Root | |||
| Sinuses of Valsalva (cm) | 3.4 ± 0.3 | 3.0 ± 0.3 | Age- and BSA-nomogram |
Left Ventricular Size
LV size is assessed by linear measurements and volumetric methods. Volumes should be indexed to BSA. The biplane method of disks (modified Simpson's rule) is the recommended 2D method.
📏 Linear Measurements
Parasternal long-axis view, perpendicular to LV long axis
At or immediately below the mitral valve leaflet tips
Calipers at endocardium–cavity interface (inner edge to inner edge)
End-diastole = first frame after MV closure (or largest dimension)
End-systole = frame after AV closure (or smallest dimension)
2D-guided preferred over blind M-mode to avoid off-axis sections
🔢 Volumetric Measurements
Biplane disk summation (Simpson's rule) — preferred 2D method
Apical 4-chamber and 2-chamber views; maximize LV area
Trace endocardium–cavity interface; exclude papillary muscles
Use contrast when ≥2 contiguous segments poorly seen
3DE preferred in labs with experience; no foreshortening
Teichholz/Quinones formulas no longer recommended
📊 Normal Values — LV Linear & Volumes
| Parameter | Men — Normal | Mildly Abnormal | Moderately Abnormal | Severely Abnormal |
|---|---|---|---|---|
| Male | ||||
| LV diastolic diameter (cm) | 4.2 – 5.8 | 5.9 – 6.3 | 6.4 – 6.8 | >6.8 |
| LV diastolic diameter/BSA (cm/m²) | 2.2 – 3.0 | 3.1 – 3.3 | 3.4 – 3.6 | >3.6 |
| LV systolic diameter (cm) | 2.5 – 4.0 | 4.1 – 4.3 | 4.4 – 4.5 | >4.5 |
| LV diastolic volume (mL) | 62 – 150 | 151 – 174 | 175 – 200 | >200 |
| LV diastolic volume/BSA (mL/m²) | 34 – 74 | 75 – 89 | 90 – 100 | >100 |
| LV systolic volume (mL) | 21 – 61 | 62 – 73 | 74 – 85 | >85 |
| Female | ||||
| LV diastolic diameter (cm) | 3.8 – 5.2 | 5.3 – 5.6 | 5.7 – 6.1 | >6.1 |
| LV diastolic diameter/BSA (cm/m²) | 2.3 – 3.1 | 3.2 – 3.4 | 3.5 – 3.7 | >3.7 |
| LV systolic diameter (cm) | 2.2 – 3.5 | 3.6 – 3.8 | 3.9 – 4.1 | >4.1 |
| LV diastolic volume (mL) | 46 – 106 | 107 – 120 | 121 – 130 | >130 |
| LV diastolic volume/BSA (mL/m²) | 29 – 61 | 62 – 70 | 71 – 80 | >80 |
| LV systolic volume (mL) | 14 – 42 | 43 – 55 | 56 – 67 | >67 |
⚖️ LV Mass & Geometry
Linear Method Formula
LV mass = 0.8 × 1.04 × [(IVS + LVID + PWT)³ − LVID³] + 0.6 g
Normal men: 49–115 g/m² (upper limit 115 g/m²)
Normal women: 43–95 g/m² (upper limit 95 g/m²)
2D method ULN: 102 g/m² (men), 88 g/m² (women)
Relative Wall Thickness (RWT)
RWT = (2 × posterior wall thickness) / LVID
Normal geometry: Normal mass + RWT ≤0.42
Concentric remodeling: Normal mass + RWT >0.42
Concentric hypertrophy: ↑mass + RWT >0.42
Eccentric hypertrophy: ↑mass + RWT ≤0.42
🖥️ 3DE Normal Values — LV Volumes & Function (BSA-indexed)
| Parameter | Aune 2010 Scandinavian · n=166 |
Fukuda 2012 Japanese · n=410 |
Chahal 2012 European/Indian · n=978 |
Muraru 2013 White European · n=226 |
WASE 2022 ★ Global · n=1,589 |
|---|---|---|---|---|---|
| EDVi (mL/m²) — mean (LLN–ULN) | |||||
| Men | 66 (46–86) | 50 (26–74) | White: 49 (31–67) | 63 (41–85) | 70 ± 15 (45–79) |
| Women | 58 (42–74) | 46 (28–64) | White: 42 (26–58) | 56 (40–78) | 65 ± 12 (43–72) |
| ESVi (mL/m²) | |||||
| Men | 29 (17–41) | 19 (9–29) | White: 19 (9–29) | 24 (14–34) | 28 ± 7 (16–32) |
| Women | 23 (13–33) | 17 (9–25) | White: 16 (8–24) | 20 (12–28) | 25 ± 6 (15–27) |
| LVEF (%) | |||||
| Men | 57 (49–65) | 61 (53–69) | White: 61 (49–73) | 62 (54–70) | 60 ± 5 (51–63) |
| Women | 61 (49–73) | 63 (55–71) | White: 62 (52–72) | 65 (57–73) | 62 ± 5 (53–65) |
| GLS (%) — WASE 3D data only | |||||
| Men | Not reported in these studies | −21 ± 3 (LLN: −19%) |
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| Women | Not reported in these studies | −22 ± 3 (LLN: −20%) |
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★ WASE 2022 — Addetia et al. JASE 2022; 1,589 healthy subjects from 19 centers in 15 countries. LLN/ULN = 2.5th–97.5th percentile. Asians have smaller volumes and higher EF than whites and blacks.
⚠️ Race matters: Asian LLN–ULN for EDV: 65–125 mL (men), 41–73 mL (women). Applying white norms to Asian subjects misclassifies ~56% as enlarged. Use population-appropriate references when available.
📅 WASE 2022 — Age-Stratified 3DE LV Values
| Parameter | 18–40 y | 41–65 y | >65 y |
|---|---|---|---|
| Men (EDVi mL/m²) | |||
| EDVi | 74.9 ± 14.4 | 67.6 ± 13.7 | 66.1 ± 13.6 |
| ESVi | 30.5 ± 7.3 | 26.9 ± 6.3 | 25.8 ± 6.9 |
| LVEF (%) | 59.5 ± 4.4 | 60.3 ± 4.7 | 61.2 ± 5.1 |
| GLS (%) | −20.7 ± 3.0 | −20.7 ± 3.1 | −20.8 ± 3.3 |
| Women (EDVi mL/m²) | |||
| EDVi | 67.7 ± 11.5 | 64.5 ± 11.9 | 60.1 ± 11.9 |
| ESVi | 25.9 ± 5.6 | 24.3 ± 5.6 | 22.4 ± 5.6 |
| LVEF (%) | 61.8 ± 4.3 | 62.3 ± 4.4 | 62.7 ± 5.3 |
| GLS (%) | −22.0 ± 2.9 | −21.9 ± 2.7 | −21.3 ± 3.3 |
ℹ️LV volumes decrease with age in both sexes. LVEF tends to increase slightly with age, especially in men. 3D GLS is stable across age groups in men; women <65 y have higher magnitude GLS than those >65 y. GCS increases in magnitude with age in both sexes.
LV Systolic Function
Global LV systolic function is assessed primarily by ejection fraction from biplane volumes, supplemented by global longitudinal strain (GLS). Regional function is assessed using the 16- or 17-segment model.
💓 Ejection Fraction
EF = (EDV − ESV) / EDV
Biplane disks (Simpson's rule) = recommended 2D method
3DE volumes preferred when feasible (more accurate, reproducible)
Do NOT derive volumes from linear measurements (Teichholz)
EF Severity Partition Cutoffs
| Sex | Normal | Mildly ↓ | Moderately ↓ | Severely ↓ |
|---|---|---|---|---|
| Men | 52–72% | 41–51% | 30–40% | <30% |
| Women | 54–74% | 41–53% | 30–40% | <30% |
📈 Global Longitudinal Strain (GLS)
GLS = (MLs − MLd) / MLd; peak value is negative
Assessed by 2D speckle-tracking in apical 4C, 2C, LAX views
Frame rate 60–90 Hz; minimize foreshortening
Normal peak GLS ≈ −20% (more negative = better)
Significant inter-vendor variability — use same vendor serially
Women have slightly more negative (higher absolute) GLS than men
GLS decreases (less negative) with age
ℹ️When reporting GLS changes, specify "increase" or "decrease in absolute value" to avoid confusion with sign convention.
See dedicated guideline card
Strain Echocardiography Guidelines
2025 ASE/EACVI consensus — GLS acquisition standards, vendor variability, updated reference ranges by sex & age, clinical applications in cardiomyopathy, chemotherapy monitoring, and valvular disease (Thomas et al., JASE 2025)
→
🗺️ LV Segmentation & Regional Function
Recommended Models
17-segment model — perfusion imaging and other modalities
16-segment model — routine wall motion assessment (apical cap excluded — imperceptible motion)
Basal & mid: anteroseptal, inferoseptal, inferior, inferolateral, anterolateral, anterior (×2 levels)
Apical: anterior, septal, inferior, lateral (+ apical cap in 17-seg)
Wall Motion Scoring
1 — Normal/Hyperkinetic
2 — Hypokinetic
3 — Akinetic
4 — Dyskinetic
WMSI = sum of all scores ÷ number of segments evaluated
Aneurysm = focal dilatation + thinning; score as akinetic or dyskinetic (no separate score)
⚠️
Regional WMA without CAD: consider myocarditis, sarcoidosis, Takotsubo, LBBB, RV pacing, RV pressure/volume overload, or post-op septal motion. Septal bounce and apical rocking suggest dyssynchrony.
⚡ Fractional Shortening (FS)
FS = (LVIDD − LVIDS) / LVIDD; normal >25%
Use is discouraged in the presence of regional WMA (coronary disease, conduction abnormalities)
May provide useful information in uncomplicated hypertension, obesity, or valvular disease without MI
Right Ventricle — Size & Function
The RV has a complex crescent shape. Assessment requires multiple views and a combination of qualitative and quantitative parameters. Use the RV-focused apical 4-chamber view for linear measurements.
See dedicated guideline card
Right Heart & Pulmonary Hypertension
2025 ASE guidelines — comprehensive RV function grading, PH probability, RAP algorithm, RV strain thresholds, WSPH classification, and updated normal values (Mukherjee et al., JASE 2025)
→
📐 Essential Views for RV Assessment
Left parasternal long-axis (PLAX)
Left parasternal short-axis (PSAX)
RV-focused apical 4-chamber (primary)
Left parasternal RV inflow view
Modified apical 4-chamber
Subcostal views
ℹ️In the RV-focused view: keep LV apex at center, display the largest basal RV diameter, avoid foreshortening. Report the window used — RV dimensions are view-dependent.
📏 RV Size — Normal Values
| Parameter | Mean ± SD | Normal Range |
|---|---|---|
| RV basal diameter (mm) | 33 ± 4 | 25–41 |
| RV mid diameter (mm) | 27 ± 4 | 19–35 |
| RV longitudinal diameter (mm) | 71 ± 6 | 59–83 |
| RVOT PLAX diameter (mm) | 25 ± 2.5 | 20–30 |
| RVOT proximal diameter (mm) | 28 ± 3.5 | 21–35 |
| RVOT distal diameter (mm) | 22 ± 2.5 | 17–27 |
| RV wall thickness (mm) | 3 ± 1 | 1–5 (>5 = abnormal) |
| RV EDV/BSA — men (mL/m²) | 61 ± 13 | 35–87 |
| RV EDV/BSA — women (mL/m²) | 53 ± 10.5 | 32–74 |
⚠️RV basal diameter >41 mm and mid-level >35 mm indicate RV dilatation.
💪 RV Systolic Function — Normal Values
| Parameter | Mean ± SD | Abnormality Threshold |
|---|---|---|
| TAPSE (mm) | 24 ± 3.5 | <17 |
| Pulsed Doppler S' (cm/s) | 14.1 ± 2.3 | <9.5 |
| Color Doppler S' (cm/s) | 9.7 ± 1.85 | <6.0 |
| RV FAC (%) | 49 ± 7 | <35 |
| RV free wall 2D strain (%) | −29 ± 4.5 | >−20 (less negative) |
| RV 3D EF (%) | 58 ± 6.5 | <45 |
| Pulsed Doppler MPI (RIMP) | 0.26 ± 0.085 | >0.43 |
| Tissue Doppler MPI (RIMP) | 0.38 ± 0.08 | >0.54 |
🔍 RV Function Parameters — Key Points
TAPSE ▼
M-mode cursor aligned along tricuspid lateral annulus in apical 4C view
Reflects RV longitudinal function; correlates with global RV systolic function
May over- or underestimate RV function due to cardiac translation
Unreliable after thoracotomy, pulmonary thromboendarterectomy, or heart transplantation
DTI S' (Tricuspid Annular Velocity) ▼
Pulsed-wave DTI at lateral tricuspid annulus; apical approach, parallel to RV longitudinal excursion
Easy, reproducible, prognostic value established
Angle-dependent; represents basal function, not global RV function
RV FAC (Fractional Area Change) ▼
FAC = (EDA − ESA) / EDA × 100%; RV-focused apical 4C view
Reflects both longitudinal and radial components; established prognostic value
Include trabeculae in cavity; does not include RVOT contribution
RIMP / MPI ▼
RIMP = (TCO − ET) / ET; TCO = tricuspid closure-to-opening time (= IVRT + IVCT)
PW Doppler: match beats with similar RR intervals
Tissue Doppler RIMP: single-beat, no RR matching needed
Falsely low when RA pressure is elevated (shortens IVRT)
RV 3D EF ▼
Most reliable when properly performed; better reproducibility than 2D parameters
Include trabeculae and moderator band in cavity; manually verify ED and ES frames
Limitations: load dependency, septal shift, poor windows, irregular rhythm
Women have higher RV EF than men; EF increases ~1%/decade with age
RV Free Wall Strain ▼
Measured in RV-focused 4C view; average of 3 free wall segments
Less confounded by overall heart motion than TAPSE or S'
Vendor-dependent; limited normative data — values may vary by software version
RV GLS (free wall + septum) typically less negative than free wall alone
Left & Right Atria
LA volume is the preferred measure of LA size, indexing to BSA. The upper normal limit was revised in 2015 from 28 to 34 mL/m². LA enlargement reflects chronicity and severity of diastolic dysfunction and LA pressure elevation.
🫀 LA Measurement Principles
Measure at end-systole (largest LA dimension, just before MV opening)
Biplane disk summation preferred; apical 4C and 2C views
Exclude pulmonary veins, LA appendage from tracings
Atrioventricular interface = mitral annulus plane (not leaflet tips)
AP diameter alone is insufficient; may not reflect true LA size
TEE should NOT be used to assess LA size (can't fit full LA)
Athletes may have enlarged LA — interpret in clinical context
📊 LA Normal Values & Severity
| Parameter | Men | Women |
|---|---|---|
| LA AP diameter (cm) | 3.0 – 4.0 | 2.7 – 3.8 |
| LA AP diameter/BSA (cm/m²) | 1.5 – 2.3 | |
| LA Volume/BSA | Classification |
|---|---|
| 16–34 mL/m² | Normal |
| 35–41 mL/m² | Mildly Enlarged |
| 42–48 mL/m² | Moderately Enlarged |
| >48 mL/m² | Severely Enlarged |
🫀 Right Atrium — Measurements
Measure at end-ventricular systole (largest RA, before TV opening)
Dedicated right heart apical 4C view (entire RA, not foreshortened)
Single-plane area-length or disk summation for RA volume
Exclude area under tricuspid annulus and RA appendage
No standard orthogonal RA view for biplane (unlike LA)
RA volumes slightly larger in men than women even after BSA indexing
| RA Parameter | Women | Men |
|---|---|---|
| RA minor axis (cm/m²) | 1.9 ± 0.3 | 1.9 ± 0.3 |
| RA major axis (cm/m²) | 2.5 ± 0.3 | 2.4 ± 0.3 |
| RA volume (mL/m²) | 21 ± 6 | 25 ± 7 |
⚠️RA area >18 cm² is considered enlarged (from 2010 ASE Right Heart guidelines).
Aortic Root & Inferior Vena Cava
Accurate aortic root assessment is critical with increasing TAVI/TAVR use. The IVC is assessed for RA pressure estimation to calculate RV systolic pressure.
🩺 Aortic Annulus Measurement
Virtual ring = basal attachments (nadirs) of the 3 aortic leaflets
Measure at mid-systole in zoom mode, inner edge to inner edge
Hinge point of RCC to commissure between LCC and NCC
Calcium protuberances = part of lumen; exclude from measurement
3D TEE and MDCT preferred for TAVI/TAVR annular sizing
Annulus is often elliptical; 2D underestimates vs. MDCT by 2–4 mm
🩺 Aortic Root Measurement
Measure all other aortic sites at end-diastole (not mid-systole)
Leading edge to leading edge (L-L) convention for root and aorta
4 sites: annulus, sinuses of Valsalva (maximal), sinotubular junction, proximal ascending aorta
2D TTE preferred over M-mode (cardiac motion causes systematic underestimation)
Asymmetric leaflet closure line = oblique cut, not at maximal diameter
Compare sinuses of Valsalva to age- and BSA-related nomograms
📊 Aortic Root Normal Dimensions
| Site | Men (cm) | Women (cm) | Indexed Men (cm/m²) | Indexed Women (cm/m²) |
|---|---|---|---|---|
| Aortic annulus | 2.6 ± 0.3 | 2.3 ± 0.2 | 1.3 ± 0.1 | 1.3 ± 0.1 |
| Sinuses of Valsalva | 3.4 ± 0.3 | 3.0 ± 0.3 | 1.7 ± 0.2 | 1.8 ± 0.2 |
| Sinotubular junction | 2.9 ± 0.3 | 2.6 ± 0.3 | 1.5 ± 0.2 | 1.5 ± 0.2 |
| Proximal ascending aorta | 3.0 ± 0.4 | 2.7 ± 0.4 | 1.5 ± 0.2 | 1.6 ± 0.3 |
ℹ️Aortic root dilatation is defined as diameter above the 95% confidence interval for BSA in the reference population. Use age-stratified nomograms: <20 years, 20–40 years, and >40 years.
🫀 Inferior Vena Cava & RA Pressure Estimation
Measurement Technique
Subcostal long-axis view, supine position
1.0–2.0 cm from junction with right atrium
Measure perpendicular to IVC long axis
Brief sniff maneuver to elicit inspiratory collapse
RA Pressure Estimation
| IVC Diameter | Collapse with Sniff | RAP (mmHg) |
|---|---|---|
| <2.1 cm | >50% | 3 (0–5) |
| Indeterminate | Indeterminate | 8 (5–10) |
| >2.1 cm | <50% | 15 (10–20) |
⚠️IVC may be dilated in normal young athletes without elevated pressure. IVC not reliable in mechanically ventilated patients. Integrate secondary RA pressure indices when IVC findings are indeterminate.
Interactive Calculators
Key quantitative calculations based on 2015 ASE/EACVI chamber quantification guidelines.
⚖️ Body Surface Area (BSA) — Mosteller Formula
Body Surface Area
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💓 LV Ejection Fraction — Biplane
LV Ejection Fraction
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⚖️ LV Mass — Linear Method
LV Mass
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📐 RV Fractional Area Change (FAC)
RV Fractional Area Change
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💠 RV RIMP (MPI) — Pulsed Doppler
RIMP (Pulsed Doppler)
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⚖️ Relative Wall Thickness (RWT) & LV Geometry
LV Geometry
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