Normal echo report for adult patient
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normal adult echocardiogram reference values parameters 2024 ASE guidelines
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I now have sufficient data from textbooks and the ASE/EACVI guidelines. Here is a complete, organized explanation of all normal adult echocardiogram parameters.
Normal Adult Echocardiogram - Parameters Explained
Below is a systematic walkthrough of every domain covered in a standard transthoracic echo (TTE) report, with normal reference values drawn from ASE/EACVI 2015 guidelines (chamber quantification) and the 2025 ASE right heart guidelines.
1. Left Ventricle (LV) - Dimensions
Measured from the parasternal long-axis view using M-mode or 2D.
| Parameter | Normal (Men) | Normal (Women) |
|---|---|---|
| LV internal diameter, diastole (LVIDd) | 42-58 mm | 38-52 mm |
| LV internal diameter, systole (LVIDs) | 25-40 mm | 22-35 mm |
| Interventricular septum, diastole (IVSd) | 6-10 mm | 6-9 mm |
| LV posterior wall, diastole (LVPWd) | 6-10 mm | 6-9 mm |
Normal wall thickness up to 10 mm (men) and 9 mm (women). Anything above that is considered hypertrophy.
2. LV Systolic Function
The most reported parameter in any echo.
| Parameter | Normal Value |
|---|---|
| Ejection Fraction (EF) | ≥ 55% (some guidelines: ≥ 52% men, ≥ 54% women) |
| Fractional shortening (FS) | 25-45% |
| LV end-diastolic volume (EDV) | Men: 62-150 mL; Women: 46-106 mL |
| LV end-systolic volume (ESV) | Men: 21-61 mL; Women: 14-42 mL |
| Global longitudinal strain (GLS) | Better than -20% (i.e., -20% to -25% is normal; less negative = impaired) |
Clinicians can reliably classify EF as:
- Normal: EF > 55%
- Mildly reduced: EF 41-54%
- Moderately impaired: EF 30-40%
- Severely impaired: EF < 30%
(Pfenninger and Fowler's Procedures for Primary Care)
3. LV Mass
| Parameter | Normal (Men) | Normal (Women) |
|---|---|---|
| LV mass (g) | 88-224 | 67-162 |
| LV mass indexed (g/m²) | 49-115 | 43-95 |
4. LV Diastolic Function
Assessed using pulsed-wave Doppler at the mitral valve tips and tissue Doppler imaging (TDI) at the mitral annulus.
| Parameter | Normal Value |
|---|---|
| E wave (early diastolic filling velocity) | 50-100 cm/s |
| A wave (atrial contraction velocity) | 30-70 cm/s |
| E/A ratio | 0.8-2.0 (age-dependent; typically > 1 in young adults) |
| Deceleration time (DT) | 160-240 ms |
| IVRT (isovolumetric relaxation time) | 70-90 ms |
| e' lateral (tissue Doppler) | ≥ 10 cm/s |
| e' septal (tissue Doppler) | ≥ 7 cm/s |
| E/e' ratio | < 14 (septal), < 10 (lateral) - elevated suggests high LVEDP |
Key rule: An e' < 8 cm/s indicates diastolic dysfunction. E/e' > 15 is consistent with elevated LV filling pressures. (Morgan & Mikhail's Clinical Anesthesiology)
Diastolic grading:
| Grade | Pattern | Pathophysiology |
|---|---|---|
| Normal | E/A > 1, normal DT | Normal relaxation |
| Grade I | E/A < 0.8, prolonged DT | Impaired relaxation |
| Grade II | E/A 0.8-2.0, normal DT (pseudonormal) | Moderate dysfunction |
| Grade III | E/A > 2, short DT | Restrictive filling |
5. Left Atrium (LA)
| Parameter | Normal (Men) | Normal (Women) |
|---|---|---|
| LA diameter (M-mode/PLAX) | 30-40 mm | 27-38 mm |
| LA volume index (biplane) | 16-34 mL/m² | 16-34 mL/m² |
An LA volume index > 34 mL/m² is abnormal in both sexes.
6. Aortic Root & Ascending Aorta
| Parameter | Normal Value |
|---|---|
| Aortic root (sinus of Valsalva) | 29-45 mm (men); 27-40 mm (women) |
| Ascending aorta | < 40 mm |
| LV outflow tract (LVOT) diameter | ~20-22 mm |
The LA and aortic root should be roughly equal in diameter (~2 cm) on PLAX view. A disparity suggests pathology. (Pfenninger and Fowler's Procedures for Primary Care)
7. Right Ventricle (RV)
Assessed from the RV-focused apical 4-chamber view.
| Parameter | Normal Value |
|---|---|
| RV basal diameter (RVD1) | < 41 mm (2025 ASE update) |
| RV mid diameter (RVD2) | 19-35 mm |
| RV longitudinal diameter (RVD3) | 59-83 mm |
| RV wall thickness | < 5 mm (normal); 5-7 mm = mild hypertrophy |
| RVOT proximal (PLAX) | 20-30 mm |
| RVOT proximal (PSAX) | 21-35 mm |
| RVOT distal (PSAX) | 17-27 mm |
| Main pulmonary artery diameter | 15-25 mm |
RV systolic function:
| Parameter | Normal Value |
|---|---|
| TAPSE (tricuspid annular plane systolic excursion) | > 17 mm |
| RV fractional area change (FAC) | > 35% |
| S' velocity (tissue Doppler, tricuspid annulus) | > 9.5 cm/s |
(2025 ASE Right Heart Guidelines; TECHmED ASE/EACVI reference table)
8. Right Atrium (RA)
| Parameter | Normal Value |
|---|---|
| RA major axis | < 53 mm |
| RA minor axis | < 44 mm |
| RA area | < 19 cm² (2025 ASE update) |
| RA volume (indexed) | Men: 25 ± 7 mL/m²; Women: 21 ± 6 mL/m² |
9. Inferior Vena Cava (IVC) - RAP Estimation
| IVC diameter | Collapsibility with inspiration | Estimated RAP |
|---|---|---|
| < 2.1 cm | > 50% | 3 mmHg (normal) |
| < 2.1 cm | < 50% | 8 mmHg |
| > 2.1 cm | > 50% | 8 mmHg |
| > 2.1 cm | < 50% | 15 mmHg |
Normal RAP = 0-5 mmHg (estimated as 3 mmHg).
10. Pulmonary Pressures
| Parameter | Normal Value |
|---|---|
| Tricuspid regurgitation velocity (TRV) | < 2.8 m/s |
| RVSP (RV systolic pressure) | < 34 mmHg (2025 ASE) |
| PASP ≈ RVSP + RAP | < 34 + 3 = ~37 mmHg in normal subjects |
11. Valves
All four valves are assessed qualitatively (and quantitatively when indicated):
Aortic valve (AV):
- Normal: 3 leaflets, thin, mobile, no calcification
- Peak velocity: < 2.0 m/s
- Mean gradient: < 10 mmHg
- AVA: > 2.0 cm²
Mitral valve (MV):
- Normal: thin, pliable leaflets; adequate systolic coaptation
- No prolapse, no restriction
Tricuspid valve (TV):
- Trivial/physiologic TR may be normal (used for PASP estimation)
- Normal TRV < 2.8 m/s
Pulmonic valve (PV):
- Normal peak velocity: < 1.0 m/s
- Trivial PR may be physiologic
12. Pericardium
- No pericardial effusion
- Normal pericardial thickness: < 3 mm
Summary of Key "Normal" Cutoffs at a Glance
| Parameter | Normal |
|---|---|
| LVEF | ≥ 55% |
| LA volume index | ≤ 34 mL/m² |
| LV mass index (men/women) | ≤ 115 / ≤ 95 g/m² |
| E/e' (average) | < 14 |
| e' septal | ≥ 7 cm/s |
| TAPSE | > 17 mm |
| RV basal diameter | < 41 mm |
| RA area | < 19 cm² |
| PASP/RVSP | < 34 mmHg |
| TRV | < 2.8 m/s |
| IVC diameter | < 2.1 cm with > 50% collapse |
Sources:
- ASE/EACVI 2015 - Recommendations for Cardiac Chamber Quantification (via TECHmED reference tables)
- 2025 ASE Right Heart Guidelines - updated severity grading for RV dimensions, TAPSE, FAC, S', RA area, TRV, RVSP (via Cardioserv)
- September 2025 ASE - Guidelines for Standardization of Adult Echocardiography Reporting
- Braunwald's Heart Disease, 12th ed.
- Morgan & Mikhail's Clinical Anesthesiology, 7th ed.
- Pfenninger and Fowler's Procedures for Primary Care, 3rd ed.
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