Basic Echo Measurement and Values

BASIC ECHO MEASUREMENTS
AND VALUES
NURAIN JURNALIS
M-MODE MEASUREMENTS
LEFT VENTRICLE (LV)
M-MODE MEASUREMENT
• Get the parasternal long axis view in 2D

• Put cursor at left ventricle area by scrolling the trackball
• Make sure that the cursor is align perpendicular to the LV
• Move the transducer higher or lower on the chest surface for better
positioning if it is not possible to place the M-Mode cursor
perpendicular to the structure.
• Then press for M-mode using the M-mode soft key control button
(1) or on touch screen M-mode soft key label (2)
• If the cursor is not perpendicular to LV, then adjust the angle soft
control button for AMM to make it perpendicular
• Then freeze the image by pressing the Freeze button
• Most of the time, upon image freeze, measurement for M-mode is
displayed on the touch screen
• If not, press Measure button on control panel and choose
Dimensions and start measuring by selecting IVSd and continue as
measurement’s sequence is automatic
AORTA / LEFT ATRIUM (AO/LA)
M-MODE MEASUREMENT
• Get the parasternal long axis view in 2D

• Put cursor at cursor at Aorta / Left Atrium area by scrolling
the trackball
• Make sure that the cursor is align perpendicular to Aorta
• Move the transducer higher or lower on the chest surface for
better positioning if it is not possible to place the M-Mode
cursor perpendicular to the structure.
• Then press for M-mode using the M-mode soft key control
button (1) or on touch screen M-mode soft key label (2)
• Most of the time, upon image freeze, measurement for M-
mode is displayed on the touch screen
Dimensions and start measuring.
• Select AoR Diam then press next meas to choose LA Dimen
TAPSE MEASUREMENT
(Tricuspid Annular Plane Systolic Excursion)
• TAPSE can be assessed with M-mode, measuring the

distance of tricuspid annular movement between end-
diastole to end- systole.
• Get the Apical 4 Chamber view in 2D
• Put cursor at the Tricuspid annulus of RV free wall area by
scrolling the trackball
Dimensions and start measuring by selecting TAPSE
NORMAL M-MODE VALUES
MEASUREMENT VALUES
Interventricular septum (IVSd) 0.7-1.1 cm
LV Diastolic Dimension (LVIDd) 4.0-5.6 cm
LV Systolic Dimension (LVIDs) 2.0-3.8 cm
End Diastoliv Volume (EDV) 95.5 ± 19.4 ml
End Systolic Volume (ESV) 38.6 ± 9.5 ml
Ejection Fraction (EF) 50 – 80%
LVOT diameter (Systole) 1.8-2.2 cm
Aortic Root (Diastole) 2.0-3.7 cm
Left Atrium (Systole) 2.0-4.0 cm
TAPSE > 1.6 cm
RV Diastolic Dimension 0.9-2.5 cm
2D MEASUREMENTS
LEFT VENTRICLE (LV)
2D MEASUREMENT
1. Get the parasternal long axis view in 2D
2. Using the trackball, scroll left ventricle area to End Diastole.
3. End-diastole: LV is at its largest dimension – frame immediately after the MV closure
4. Put caliper at septum (IVSd) area. Just enter the cursor at
5. Place calipers more apically allowing for the full thickness of the septum to be correctly
measured.
6. Remember to avoid measuring together the RV trabeculation (if present)
7. Continue to measure the Left Ventricle (LVIDd). Make sure it reflect the perpendicular
measurement of the LV SEPTUM
8. Then continue to measure the LV Posterior wall (LVPWd).
9. Be careful when measuring the posterior wall and the LV in the presence of prominent
papillary muscles. The papillary muscle falls within the LV dimension and not the
posterior wall dimensions.
10. Now scroll to End Sytole
11. End Systole: LV is at its smallest dimension – frame immediately after the AV closure
12. Continue for step 4-8
• Freeze the image by pressing the Freeze button

• Most of the time, upon image freeze, measurement for 2D is displayed on the touch screen
• The IVS, LV, PW measurements do not have to be in a straight line.
• As long as all the measurements are within the basal section of the heart focus on the best
caliper placement based on the structure you are measuring.
• In the presence of sigmoid septum – do not measure the bulge of the septum be sure to
measure the septum just apical to the bulge.
• The same carries through for the LV; measure the LV cavity apically to the bulge of the Sigmoid LEFT VENTRICLE POSTERIOR WALL
Septum .
LVOT 2D MEASUREMENT

2. LVOT diameter is measured in the
parasternal long-axis view in mid-systole
from the white–black interface of the
septal endocardium to the anterior
mitral leaflet, parallel to the aortic valve
plane and within 0.5–1.0 cm of the valve
orifice.
3. In PLAX view, zoom to LVOT area
4. Freeze the image
5. Scroll to mid systole
6. Press LVOT DIAM on the touch screen
7. Measure the LVOT diameter from inner
edge to inner edge
AORTIC 2D MEASUREMENT

2. In PLAX view, zoom to Aorta area
3. Freeze the image
4. Scroll to end diastole
5. Press Vessel on the touch screen
6. Measure the following diameter from
leading edge to leading edge :
• Aortic annulus
• Sinus of Vasalva
• Sinotubular Junction
• Ascending Aorta
1. Go to LV 4 chamber view and adjust the depth to focus on LV
2. Freeze the image
Simpson EF %
3. Scroll to end-diastole or when the mitral valve is open and LV cavity is
the biggest 10
4. Go to EF & Volume (2D) in Measurement on touch screen and press

A4Cd
4 8 13
5. Depending on system setting :
• Trace the LV endocardial border 6
• Can reverse the trackball to undo the tracing for adjustment
• Or place points on both annulus and drag towards apex.
• Then adjust the borders by pressing and dragging the circles to
the endocardial tracing
• Papillary muscles should be excluded from the tracing
6. Then press the left trackball button set on next measurement
7. Scroll the LV image to end-systole or when the mitral valve closes and
LV cavity is the smallest
8. Then A4Cs on the touch screen
9. Repeat step 5
10. Then press the small middle trackball button set on end
11. To do Biplane Simpson (modified Simpson using both LV 4 chamber
and 2 chamber), go to LV 2 Chamber view
12. Repeat step 2 to 10
13. Instead of pressing A4Cd and A4Cs  press A2Cd and A2Cs
Normal ranges for two-dimensional echocardiography obtained LVEF as
per American Society of Echocardiography and the European
Association of Cardiovascular Imaging are:
LVEF (%) among the male population:
• 52% to 72% normal range The simplest classification as per American College
of Cardiology (ACC) that is used clinically as follows:
• 41% to 51% mildly abnormal
• 30% to 40% moderately abnormal
• Hyperdynamic = LVEF greater than 70%
• Less than 30% severely abnormal
• Normal = LVEF 50% to 70% (midpoint 60%)
• Mild dysfunction = LVEF 40% to 49% (midpoint
LVEF (%) among the female population: 45%)
• Moderate dysfunction = LVEF 30% to 39%
• 54% to 74% normal range (midpoint 35%)
• 41% to 53% mildly abnormal • Severe dysfunction = LVEF less than 30%
• 30% to 40% moderately abnormal
• Less than 30% severely abnormal
1. Go to LV 4 chamber view Left Atrial and Right Atrial Volume
2. Freeze the image
3. Using the trackball, scroll to end-ventricular systole, when the LA is at
its maximum size
LA 4Cs
5. Trace the LA border
• Can reverse the trackball to undo the tracing for adjustment
• Implement the 4 steps to mastering the correct way to measure LA
volume
• Correct length measurement – perpendicular, mid-point to mid-
point
• Don’t include extra structures – avoid LAA, pulmonary veins, etc
• Avoid foreshortening of the LA – Focus on the LA plane not the LV
plane
• Maintain the plane when rotating – the 4C and 2C length should
never change more than 5mm
6. Then, go to RA 4 Chamber view
8. Press RA 4Cs to measure
4
9. Trace the RA border
8
1. Go to LV 4 chamber view
2. Freeze the image Left Atrial Volume Index (LAVi)
3. Using the trackball, scroll to end-ventricular systole, when the LA is at
its maximum size LAVI
Interpretation
(mL/m2)
LA 4Cs < 16 Below normal range
5. Trace the LA border 16 - 35 Normal range

• Can reverse the trackball to undo the tracing for adjustment 35 - 42 Mildly abnormal
4 8
• Implement the 4 steps to mastering the correct way to measure LA 42 - 48
Moderately
volume abnormal
• Correct length measurement – perpendicular, mid-point to mid- ≥ 48 Severely abnormal
point
• Don’t include extra structures – avoid LAA, pulmonary veins, etc
• Avoid foreshortening of the LA – Focus on the LA plane not the LV
plane
• Maintain the plane when rotating – the 4C and 2C length should
never change more than 5mm
6. Then, go to LV 2 Chamber view
8. Instead of pressing LA 4Cs, press LA 2Cs to measure
• Gender differences are then accounted for by indexing the volume to

body surface area (BSA)  need to enter patient’s height and weight.
• LAVI = LA Volume / BSA
IVC
2D
1. Get the subcostal view in 2D
2. Long axis view of the IVC
3. Open up IVC so the diameter is at its fullest the entire length
of the IVC
4. Show IVC emptying into the right atrium
5. The IVC diameter can be measured approximately 3–4 cm
from the junction of the IVC and the right atrium 2D
6. Be sure to measure Inner-to-Inner Edge
7. Measure perpendicular to the vessel
8. The IVC should NOT be measured at the junction of the IVC
and RA
MMODE
1. Place cursor at IVC approximately 3–4 cm from the junction RAP
of the IVC and the right atrium
2. Press the MMODE button
3. M-Mode allows for better interrogation of the IVC over time
and displays: pre sniff, sniff and post sniff views in the same
image
4. Be sure to measure Inner-to-Inner Edge
MITRAL VALVE
Short Axis
MITRAL VALVE AREA BY PLANIMETRY
AORTA
SAX VIEW
XPLANE
PLAX VIEW
RVOT
REGIONAL WALL MOTION ABNORMALITY (RWMA)
DOPPLER MEASUREMENTS
CW PW
• MS • MITRAL INFLOW E/A

• MR • TDI
• AS • LVOT
• AR • RVOT
• TS
• TR
• PS
• PR
MITRAL VALVE
MITRAL STENOSIS (MS)
• Apical 4 Chamber
• Align cursor to be parallel to mitral valve
• Press CW (Continuous wave) button
• Press Freeze button
• Select Mitral Valve on touch screen
• For mitral valve gradient, press on MV VTI on touch screen
• Trace the Doppler diastolic mitral flow waveform on the display screen
• Result will give mean and max mitral valve gradient
• To measure the mitral valve area by PHT (MVA P½ time), press MV P½T
• Then click on the peak E and follow along the deceleration slope of E
wave on Doppler spectral display of transmitral flow and mitral valve
area is calculated automatically
MS grading Mean Gradient MVA PA Pressure

(mmHg) (cm2) (mmHg)
Mild <5 >1.5 - 4.0 <30
Moderate 5-10 1.0-1.5 30-50
Severe >10 <1.0 >50
MITRAL REGURGITATION (MR)
PISA MR
• Apical 4 Chamber view

• Step 1
• On the Color doppler
• Zoomed on MV leaflets
• Adjust Color Doppler baseline towards direction of regurgitant jet : 30-40 cm/sec
• Select Mitral Valve, then select PISA (MR) on touch screen
• Press MR Alias Vel on touch screen and enter the aliasing velocity value
• Then press MR Radius and measure radius from 1st aliasing threshold to vena
contracta
• Step 2
• Go back to 2D
• On the Color doppler 2
• Align cursor to be parallel to mitral valve
• Select Mitral Valve, then select PISA (MR) on touch screen
• Then select MR VTI and trace along the MR Doppler
AORTIC VALVE
AORTIC STENOSIS
(AS)
• Align cursor to be parallel to aortic valve PLAX APICAL 5C
• Select Aortic Valve on touch screen
• For aortic valve gradient, press on AV VTI on touch screen
• Trace the Doppler systolic Aortic flow waveform on the display
screen
• Result will give mean and max aortic valve gradient
AS Grading Mean Gradient Peak Velocity AVA (cm2) Dimensionless

(mm Hg) (m/s) Index
Normal <10 <2.5 >2.5

Mild <20 2.6-2.9 >1.5 > 0.50
Moderate 20-40 3.0-4.0 1.0-1.5 0.25 – 0.50
Severe ≥40 ≥4.0 <1.0 < 0.25
1
AORTIC VALVE AREA (AVA VTI)

2. Freeze and measure LVOT Diameter by pressing LVOT DIAM on touch screen
11
3. Then go to Apical 5 Chamber view
4. Align cursor to be parallel to aortic valve
5. Press CW (Continuous wave) button
6. Press Freeze button
7. Select Aortic Valve on touch screen
8. For aortic valve gradient, press on AV VTI on touch screen
9. Trace the Doppler systolic Aortic flow waveform on the display screen
10. Result will give the AV VTI
9 17
11. Then in Apical 5 Chamber again, align cursor to be parallel to LVOT
12. Then put the marker at LVOT area
13. Press PW button
16. For LVOT gradient, press on LVOT VTI on touch screen
17. Trace the Doppler systolic LVOT flow waveform on the display screen
18. Result will give the LVOT VTI
19. All the 3 measurements will give result for AVA VTI
AORTIC REGURGITATION (AR)
• Align cursor to be parallel to aortic valve
• Press CW button
• Select Aortic Valve on touch screen PLAX APICAL 5C
• For AR Pressure Half Time, press on AI P1/2T on touch screen
• Trace the top Doppler diastolic Aortic flow waveform on the display
screen
• Result will give the pressure half time (PHT) for AR
DESCENDING AORTA GRADIENT
FOR SEVERE AR
• Go to Suprasternal view
• Align cursor to be parallel to descending aorta
• Press PW button
• Select Aortic Valve on touch screen
• For mitral valve gradient, press on AI REVERSAL
VMAX on touch screen
• If not available, just press measure and trace
the aveform
• Trace the Doppler systolic Aortic flow waveform
on the display screen
• Result will give mean and max aortic valve
gradient
LVOT GRADIENT
1. Go to Apical 5 Chamber view

2. Align cursor across aortic valve 1 4
3. Then align cursor to be parallel to LVOT
4. Then put the sample volume at LVOT area
5. Press PW button
8. For LVOT gradient, press on LVOT VTI on
touch screen
9. Trace the Doppler systolic LVOT flow
waveform on the display screen
10. Result will give the LVOT gradient
9, 10
TRICUSPID VALVE
TRICUSPID STENOSIS (TS)
• Put colour (CFM) on tricuspid valve
• Put cursor on TR jet
• Press CW button
• Press Freeze button when tracing is nice
• Select Tricuspid Valve on touch screen
• Measure the peak gradient by pressing TV VTI on
touch screen
• Trace the Doppler gradient as shown in the picture
TRICUSPID REGURGITATION (TR)
• Put colour (CFM) on tricuspid valve
• Put cursor on TR jet
• Press CW button
• Select Tricuspid Valve on touch screen
• Measure the peak gradient by pressing TR Vmax on touch screen
• Put the reading on the peak of the Doppler gradient as shown in the
picture
PULMONIC VALVE
PULMONIC STENOSIS (PS)
1. Go to Short Axis AO/PA view

2. Align cursor across pulmonic artery
3. Press CW button
5. Select Pulm Valve on touch screen
6. Select PV Max or PV VTI on touch screen
PULMONIC REGURGITATION (PR)

3. Press CW button
6. Select PI EDG on touch screen
PULMONARY ACCELERATION TIME (PAT)

2. Put sample volume at annulus
3. Press PW button
6. Select PA Acc on touch screen
1-4
RVOT GRADIENT

3. Then align cursor to be parallel to RVOT
4. Then put the sample volume at RVOT
area Peak systolic gradients across the right ventricular outflow tract and the
pulmonary vessels.
5. Press PW button
8. For RVOT gradient, press on RVOT VTI on
touch screen
9. Trace the Doppler systolic RVOT flow
waveform on the display screen
10. Result will give the RVOT gradient
9, 10
PATENT DUCRUS ARTERIOSUS (PDA)

2. On color
3. Align cursor across PDA
4. Press CW
5. Press measure button (on control panel next to
trackball) and put caliper at Systolic (S) to get the
gradient
LEFT VENTRICLE
MITRAL INFLOW (E/A) MEASUREMENT
• Align cursor to be parallel to mitral inflow
• Sample volume placed on Mitral Valve leaflets tips during diastole.
• Press PW (Pulse wave) button
• Select Mitral Valve on touch screen
• Click on MV Peak E Vel and click on Peak E Doppler image on screen
• After pressing set button, it will automatically go to MV Decel Time
• Just drag the cursor following the deceleration slope from MV Peak E tip until reach baseline
• Then press set button
• Then it will automatically go to MV Peak A Vel
• Bring cursor to tip of MV Peak A and press set
TISSUE DOPPLER IMAGING (TDI) SEPTAL
• Apical 4C view
• Align cursor at the septal or lateral annulus of the mitral valve
• Place 3-5 mm PW Doppler sample volume at the septal or
lateral annulus of the mitral valve
• Sample volume must be aligned parallel to the myocardium in
the area of the mitral annulus being interrogated
• Press TDI button on touch screen
• Press PW (Pulse wave) button LATERAL
• Select TDI on touch screen
• For Septal TDI :
• Click on Med E’ Vel on touch screen
• Then click next meas for Med A’ Vel, followed by Med S
Vel
• For Lateral TDI :
• Click on Lat E’ Vel on touch screen
• Then click next meas for Lat A’ Vel, followed by Lat S Vel
DIASTOLIC FUNCTION GRADING
a
LV MPI (@ LIMP) LLIMP

(MCOT – ET)
• LV Index of Myocardial Performance

• Global index of both systolic and diastolic function o the
left ventricle
• Apical 5 Chamber view b
• Align cursor to LVOT
• The LVET is measured with PW of LVOT
• Then put the sample volume at LVOT area
• Press PW button
• Freeze and choose LVET on touch screen
• Measure as in picture b
• The mitral (valve) closure-opening time is measured using
CW of the MR jet MCOT
• Go to Apical 4 chamber view
• Align cursor across mitral valve and press CW button
• Freeze and press MCOT on touch an measure as in picture LVET
a
RIGHT VENTRICLE ASSESSMENT
RV
2D RV DIMENSION
• RV should be 2/3 size LV.

• If same size then dilated.
• Moderator band seen in apex.
• Trabeculated.
PARAMETER NORMAL RANGE (CM)
RV BASAL DIAMETER (RVD1) 2.5 – 4.1
RV MID DIAMETER (RVD2) 1.9 – 3.5
RV LONGITUDINAL DIAMETER (RVD3) 5.9 - 8.3
TAPSE MEASUREMENT
(Tricuspid Annular Plane Systolic Excursion)
• TAPSE can be assessed with M-mode, measuring the

distance of tricuspid annular movement between end-
diastole to end- systole.
• Get the Apical 4 Chamber view in 2D
• Put cursor at the Tricuspid annulus of RV free wall area by
scrolling the trackball
Dimensions and start measuring by selecting TAPSE
TDI S Wave Velocity
• Apical 4C view
• Align cursor at the annulus of the tricuspid
valve
• Place 3-5 mm PW Doppler sample volume at
the tricuspid annulus of the RV free wall
• Press TDI button on touch screen
• Press PW (Pulse wave) button
• Select TDI on touch screen
• Click on RV S Vel on touch screen
RV FAC
• Scroll to diastole and press EF & Volume on touch
screen
• Press RV FAC and then press RV EDA
• Trace RV endocardium diastole from the annulus,
along the free wall to the apex, and then back to the
annulus, along the interventricular septum
• Avoid trabeculations
• Then scroll to systole and press RV ESA
• Trace RV endocardium systole from the annulus,
along the free wall to the apex, and then back to the
annulus, along the interventricular septum
• Normal > 35 %
b
RV MPI (@ RIMP)
• RV Index of Myocardial Performance

• Global index of both systolic and diastolic function o the right
ventricle
• Short axis AO/PA level
• Align cursor to RVOT/PA
• The RVET is measured with PW of RVOT a
• Place sample volume at just below the pulmonary valve in
the RVOT view
• Press PW button
• Freeze and choose RVET on touch screen
• Measure as in picture b
• The tricuspid (valve) closure-opening time is measured using
CW of the TR jet @ a–b
• Go to Apical 4 chamber view b
• Align cursor across tricuspid valve and press CW button
• Freeze and press TCOT on touch an measure as in picture a
QPQS
LVOT 2D MEASUREMENT

2. LVOT diameter is measured in the
parasternal long-axis view in mid-systole
from the white–black interface of the
septal endocardium to the anterior
mitral leaflet, parallel to the aortic valve
plane and within 0.5–1.0 cm of the valve
orifice.
4. Freeze the image
5. Scroll to mid systole
6. Press LVOT DIAM on the touch screen
7. Measure the LVOT diameter from inner
edge to inner edge
RVOT 2D MEASUREMENT
1-4
RVOT VTI

3. Then align cursor to be parallel to RVOT
4. Then put the sample volume at RVOT area
5. Press PW button
8. For RVOT gradient, press on RVOT VTI on touch screen
9. Trace the Doppler systolic RVOT flow waveform on the display
screen
10. Result will give the RVOT VTI
9, 10
LVOT VTI
1. Go to Apical 5 Chamber view

2. Align cursor across aortic valve
1 4
3. Then align cursor to be parallel to LVOT
4. Then put the sample volume at LVOT area
5. Press PW button
8. For LVOT gradient, press on LVOT VTI on touch screen
9. Trace the Doppler systolic LVOT flow waveform on the display
screen
10. Result will give the LVOT VTI
9, 10

Basic Echo Measurement and Values

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Basic Echo Measurement and Values

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BASIC ECHO MEASUREMENTS

• Get the parasternal long axis view in 2D

• Get the parasternal long axis view in 2D

• TAPSE can be assessed with M-mode, measuring the

• Freeze the image by pressing the Freeze button

1. Get the parasternal long axis view in 2D

1. Get the parasternal long axis view in 2D

4. Go to EF & Volume (2D) in Measurement on touch screen and press

5. Trace the LA border 16 - 35 Normal range

• Gender differences are then accounted for by indexing the volume to

• MS • MITRAL INFLOW E/A

MS grading Mean Gradient MVA PA Pressure

• Apical 4 Chamber view

AS Grading Mean Gradient Peak Velocity AVA (cm2) Dimensionless

Normal <10 <2.5 >2.5

1. In PLAX view, zoom to LVOT area

1. Go to Apical 5 Chamber view

1. Go to Short Axis AO/PA view

1. Go to Short Axis AO/PA view

1. Go to Short Axis AO/PA view

1. Go to Short Axis AO/PA view

1. Go to Short Axis AO/PA view

LV MPI (@ LIMP) LLIMP

• LV Index of Myocardial Performance

• RV should be 2/3 size LV.

• TAPSE can be assessed with M-mode, measuring the

• RV Index of Myocardial Performance

1. Get the parasternal long axis view in 2D

1. Go to Short Axis AO/PA view

1. Go to Apical 5 Chamber view

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