Methods
It is critical that users apply the same measurement methodolgy as used in the generation of the reference values. For the most part (except where otherwise noted), measurements included herein abide by the recent ASE Pediatric Guidelines .
Briefly, the following principles apply:
- M-Mode:
- Measurements are made using the "leading edge to leading edge" convention.
- 2D:
- Measurements are made from the endocardial surfaces; vascular diameters use the "inner edge to inner edge" convention, measuring perpendicular to the vessel wall.
Details
The following list provides technical detail for individual site measurements:
- RV Anterior Wall Diastolic Dimension (M-Mode)
- Units: mm
- View: parasternal
- Timing: diastole
- Where to measure: RV free wall
- RV End Diastolic Dimension (M-Mode)
- Units: mm
- View: parasternal
- Timing: diastole
- Where to measure: RV free wall to RV septal surface
- Left Atrial Diameter (M-Mode)
- Units: mm
- View: parasternal
- Timing: systole
- Where to measure: AP diameter at level of aortic root
- Interventricular Septum, Diastole (M-Mode)
- Units: mm
- View: parasternal
- Timing: diastole
- Where to measure: RV endocardial surface to LV endocardial surface
- LV End-Diastolic Diameter (M-Mode)
- Units: mm
- View: parasternal
- Timing: diastole
- Where to measure: posterior septal surface to anterior surface of posterior wall; excluding papillary muscles
- LV Posterior Wall, Diastole (M-Mode)
- Units: mm
- View: parasternal
- Timing: diastole
- Where to measure:
- Interventricular Septum, Systole (M-Mode)
- Units: mm
- View: parasternal
- Timing: systole
- Where to measure:
- LV End-Systolic Diameter (M-Mode)
- Units: mm
- View: parasternal
- Timing: systole
- Where to measure:
- LV Posterior Wall, Systole (M-Mode)
- Units: mm
- View: parasternal
- Timing: systole
- Where to measure:
- LV Mass (M-Mode)
- Units: g
- View: parasternal
- Timing: diastole
- Where to measure: see: IVSd, LVEDD, and LVPWd
- Left Atrial Diameter (2D)
- Units: mm
- View: parasternal
- Timing: systole
- Where to measure: largest A-P diameter
- LA Major Diameter (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: maximal distance from the center of the mitral annulus to the center of the superior LA wall, parallel to the interatrial septum
- LA Minor Diameter (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: maximal distance from the atrial septum to the lateral atrial wall
- LA Area (2D)
- Units: cm^2
- View: A4C
- Timing: systole
- Where to measure: endocardial surface, from the lateral aspect of the mitral annulus to the septal aspect, excluding the pulmonary veins and appendage
- Mitral Valve, Lateral (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: leaflet hingepoints
- Mitral Valve, Antero-Posterior (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: leaflet hingepoints
- Mitral Valve Area (2D)
- Units: cm^2
- View: (derived)
- Timing: diastole
- Where to measure: n/a
- Interventricular Septum, Diastole (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: RV endocardial surface to LV endocardial surface
- Interventricular Septum, Diastole (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: RV endocardial surface to LV endocardial surface
- Interventricular Septum, Systole (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: RV endocardial surface to LV endocardial surface
- LV End Diastolic Diameter (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: septal endocardial surface to posterior wall endocardial surface; just below mitral annulus
- LV End Diastolic Diameter (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: septal endocardial surface to posterior wall endocardial surface; just below mitral annulus
- LV End Systolic Diameter (2D)
- Units: mm
- View: PSAX
- Timing: systole
- Where to measure: septal endocardial surface to posterior wall endocardial surface; just below mitral annulus
- LV End Systolic Diameter (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: septal endocardial surface to posterior wall endocardial surface; just below mitral annulus
- LV Posterior Wall, Diastole (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: posterior wall endocardial surface to epicardial surface
- LV Posterior Wall, Diastole (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: posterior wall endocardial surface to epicardial surface
- LV Posterior Wall, Systole (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: posterior wall endocardial surface to epicardial surface
- LV Area, End-Diastole (SAX) (2D)
- Units: cm^2
- View: PSAX
- Timing: diastole
- Where to measure: LV short axis endocardial area
- LV Epicardial Area, End-Diastole (SAX) (2D)
- Units: cm^2
- View: PSAX
- Timing: diastole
- Where to measure: LV short axis epicardial area
- LV Major, End-Diastole (A4C) (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
- LV Major, Epicardial, End-Diastole (A4C) (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical epicardium
- LV Area, End-Diastole (A4C) (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: LV endocardial borders (excluding the papillary muscles)
- LV Major Diameter, End-Systole (A4C) (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
- LV Area, End-Systole (A4C) (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: LV endocardial borders (excluding the papillary muscles)
- LV Major Diameter, End-Diastole (A2C) (2D)
- Units: mm
- View: A2C
- Timing: diastole
- Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
- LV Area, End-Diastole (A2C) (2D)
- Units: mm
- View: A2C
- Timing: diastole
- Where to measure: LV endocardial borders (excluding the papillary muscles)
- LV Major Diameter, End-Systole (A2C) (2D)
- Units: mm
- View: A2C
- Timing: systole
- Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
- LV Area, End-Systole (A2C) (2D)
- Units: mm
- View: A2C
- Timing: systole
- Where to measure: LV endocardial borders (excluding the papillary muscles)
- LA Volume (2D)
- Units: ml
- View: A4C
- Timing: systole
- Where to measure:
- LV End-Diastolic Volume (2D)
- Units: ml
- View: apical, PSAX, or subcostal
- Timing: diastole
- Where to measure:
- LV End-Diastolic Volume, Epicardium (2D)
- Units: ml
- View: apical, PSAX, or subcostal
- Timing: diastole
- Where to measure:
- LV End-Systolic Volume (2D)
- Units: ml
- View: apical
- Timing: systole
- Where to measure:
- LV Ejection Fraction (2D)
- Units: %
- View:
- Timing:
- Where to measure:
- LV Mass (2D)
- Units: g
- View: parasternal, apical
- Timing: diastole
- Where to measure: see components: PSAX Epi area, PSAX endo area, LV Major
- LV Mass to Volume Ratio (2D)
- Units:
- View:
- Timing: diastole
- Where to measure: LV Mass/EDV
- LV Posterior Wall to EDD Ratio (2D)
- Units:
- View:
- Timing: diastole
- Where to measure: LVPWd/LVEDD
- LV Sphericity Index (2D)
- Units:
- View: SAX, A4C
- Timing: diastole
- Where to measure: LV Major/Minor
- Left Ventricular Outflow Tract (2D)
- Units: mm
- View: PLAX
- Timing: landmarks not specified in reference
- Where to measure: timing not specified in reference
- Aortic Valve Annulus (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: leaflet hingepoints
- Aortic Valve Annulus (d) (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: leaflet hingepoints
- Left Main Coronary Artery (2D)
- Units: mm
- View: PSAX
- Timing: maximum diameter
- Where to measure:
- Left Anterior Descending Coronary Artery (2D)
- Units: mm
- View: PSAX
- Timing: maximum diameter
- Where to measure:
- Circumflex Coronary Artery (2D)
- Units: mm
- View: PSAX
- Timing: maximum diameter
- Where to measure:
- Proximal Right Coronary Artery (2D)
- Units: mm
- View: PSAX
- Timing: maximum diameter
- Where to measure:
- Mid Right Coronary Artery (2D)
- Units: mm
- View: PSAX
- Timing: maximum diameter
- Where to measure:
- Distal Right Coronary Artery (2D)
- Units: mm
- View:
- Timing: maximum diameter
- Where to measure:
- Sinus of Valsalva (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: largest diameter of sinus
- Sinus of Valsalva (d) (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: largest diameter of sinus
- Sino-Tubular Junction (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: where the aortic sinuses end and the aorta becomes a tubular structure.
- Sino-Tubular Junction (d) (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: where the aortic sinuses end and the aorta becomes a tubular structure.
- Ascending Aorta (2D)
- Units: mm
- View: PLAX or high RSB
- Timing: systole
- Where to measure: at the level of the RPA
- Ascending Aorta (d) (2D)
- Units: mm
- View: PLAX or high RSB
- Timing: diastole
- Where to measure: at the level of the RPA
- Aortic Arch (2D)
- Units: mm
- View: SSN
- Timing: diastole
- Where to measure: landmarks not specified in reference
- Proximal Transverse Arch (2D)
- Units: mm
- View: SSN
- Timing: systole
- Where to measure: between 1st BCA and LCCA
- Distal Transverse Arch (2D)
- Units: mm
- View: SSN
- Timing: systole
- Where to measure: between LCCA and LSA
- Aortic Isthmus (2D)
- Units: mm
- View: SSN
- Timing: systole
- Where to measure: narrowest segment distal to LSA
- Descending Aorta (2D)
- Units: mm
- View: SSN
- Timing: systole
- Where to measure: immed. beyond isthmus
- Descending Aorta (2D)
- Units: mm
- View: SSN
- Timing: diastole
- Where to measure: landmarks not specified in reference
- Abdominal Aorta (2D)
- Units: mm
- View: SUBC
- Timing: systole
- Where to measure: at level of diaphragm
- Inferior Vena Cava (2D)
- Units: mm
- View: SUBC Sagittal
- Timing: diastole
- Where to measure: just below diaphragm
- RA Major Diameter (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: maximal distance from the center of the tricuspid annulus to the center of the superior RA wall, parallel to the interatrial septum
- RA Minor Diameter (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: maximal distance from the atrial septum to the lateral atrial wall
- RA Area (2D)
- Units: cm^2
- View: A4C
- Timing: systole
- Where to measure: endocardial surface, from the lateral aspect of the tricuspid annulus to the septal aspect, excluding the SVC, IVC, and RA appendage
- Tricuspid Valve, Lateral (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: leaflet hingepoints
- Tricuspid Valve, Antero-Posterior (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: leaflet hingepoints
- Tricuspid Valve Area (2D)
- Units: cm^2
- View: (derived)
- Timing: diastole
- Where to measure: n/a
- RV Anterior Wall Thickness (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: Exclude RV trabeculations, epicardial fat, and papillary muscle from RV endocardial border
- RV Free Wall Thickness (2D)
- Units: mm
- View: SUBC
- Timing: diastole
- Where to measure: Exclude RV trabeculations, epicardial fat, and papillary muscle from RV endocardial border
- RV Basal Diameter (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: maximal distance from RV free wall to septum, parallel to annulus, basal 1/3rd of RV
- RV Mid-Cavitary Diameter (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: RV free wall to septal endocardium, parallel to annulus, midway between annulus and apex
- RV Length (2D)
- Units: mm
- View: A4C
- Timing: diastole
- Where to measure: midpoint of TV annulus to RV apex
- RV Length, End-Systole (2D)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: midpoint of TV annulus to RV apex
- RV Anteroinferior Basal Diameter (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: maximal diameter at the basal third of the RV cavity from its anterior to inferior walls while maintaining a parallel orientation with the annulus.
- RV Anteroposterior Diameter (2D)
- Units: mm
- View: PLAX
- Timing: diastole
- Where to measure: maximal diameter of RV cavity from its anterior to septal walls.
- RV Outflow Diameter, PSAX (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: From the RV free wall above the aortic valve to the anterior aortic wall.
- RV End-Diastolic Area (A4C) (2D)
- Units: cm^2
- View: A4C
- Timing: diastole
- Where to measure: RV endocardial border (include trabeculations within the area)
- RV End-Systolic Area (A4C) (2D)
- Units: cm^2
- View: A4C
- Timing: systole
- Where to measure: Rotated CCW from traditional A4C; RV endocardial border (include trabeculations within the area)
- RV Fractional Area Change (A4C) (2D)
- Units: %
- View: A4C
- Timing: n/a
- Where to measure: (EDA - ESA) / EDA
- RV End-Diastolic Area (RV 3C) (2D)
- Units: cm^2
- View: RV A3C
- Timing: diastole
- Where to measure: Rotated CCW from traditional A4C; RV endocardial border (include trabeculations within the area)
- RV End-Systolic Area (RV 3C) (2D)
- Units: cm^2
- View: RV A3C
- Timing: systole
- Where to measure: RV endocardial border (include trabeculations within the area)
- RV Fractional Area Change (A3C) (2D)
- Units: %
- View: A3C
- Timing: n/a
- Where to measure: (EDA - ESA) / EDA
- RV Global FAC (2D)
- Units: %
- View: Apical
- Timing: n/s
- Where to measure: (FAC (A4C) + FAC (A3C) / 2
- Tricuspid Annular Plane Systolic Excursion (M-Mode)
- Units: mm
- View: A4C
- Timing: systole
- Where to measure: M-Mode through the lateral aspect of the tricuspid annulus while maintaining vertical alignment with the apex
- RV Peak Longitudinal Strain (A4C) (STE/Strain)
- Units: %
- View: A4C
- Timing: systole
- Where to measure: peak longitudinal strain, RV lateral wall endocardial border, average of the basal, middle, and apical segments
- RV Peak Longitudinal Strain (A3C) (STE/Strain)
- Units: %
- View: A3C
- Timing: systole
- Where to measure: peak longitudinal strain, average of inferior/anterior wall segments, from the lateral basal attachment of the TV to just before the pulmonary valve attachment at the infundibulum
- RV Global Peak Longitudinal Strain (STE/Strain)
- Units: %
- View: Apical
- Timing: n/a
- Where to measure: (RV PLS (A4C) + RV PLS (A3C))/2
- Pulmonary Valve Annulus (2D)
- Units: mm
- View: PSAX
- Timing: systole
- Where to measure: leaflet hinge points
- Pulmonary Valve Annulus (d) (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: leaflet hinge points
- Pulmonary Valve Annulus, PLAX (2D)
- Units: mm
- View: PLAX
- Timing: systole
- Where to measure: leaflet hinge points
- Main Pulmonary Artery (2D)
- Units: mm
- View: PSAX
- Timing: systole
- Where to measure: between the pulmonary sinotubular junction and bifurcation
- Main Pulmonary Artery (d) (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: 1 cm distal to PV annulus
- Right Pulmonary Artery (2D)
- Units: mm
- View: PSAX
- Timing: systole
- Where to measure: immediately beyond bifurcation
- Right Pulmonary Artery (d) (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: 1 cm beyond bifurcation
- Left Pulmonary Artery (2D)
- Units: mm
- View: PSAX
- Timing: systole
- Where to measure: immediately beyond bifurcation
- Left Pulmonary Artery (d) (2D)
- Units: mm
- View: PSAX
- Timing: diastole
- Where to measure: 1 cm beyond bifurcation
- MV E (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak early diastolic mitral inflow, PW sample volume at leaflet tips
- MV A (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak late diastolic mitral inflow, PW sample volume at leaflet tips
- MV E/A ratio (Doppler)
- Units:
- View: apical
- Timing: diastole
- Where to measure:
- TV E (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak early diastolic tricuspid inflow, PW sample volume at leaflet tips
- TV A (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak late diastolic tricuspid inflow, PW sample volume at leaflet tips
- TV E/A ratio (Doppler)
- Units:
- View: apical
- Timing: diastole
- Where to measure:
- LV TDI E' (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak early diastolic annular velocity
- LV TDI A' (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak late diastolic annular velocity
- LV TDI S' (Doppler)
- Units: cm/s
- View: apical
- Timing: systole
- Where to measure: peak systolic annular velocity
- Septal TDI E' (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak early diastolic annular velocity
- Septal TDI A' (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak late diastolic annular velocity
- Septal TDI S' (Doppler)
- Units: cm/s
- View: apical
- Timing: systole
- Where to measure: peak systolic annular velocity
- RV TDI E (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak early diastolic annular velocity
- RV TDI A (Doppler)
- Units: cm/s
- View: apical
- Timing: diastole
- Where to measure: peak late diastolic annular velocity
- RV TDI E/A Ratio (Doppler)
- Units:
- View: apical
- Timing: diastole
- Where to measure:
- RV TDI S (Doppler)
- Units: cm/s
- View: apical
- Timing: systole
- Where to measure: peak systolic annular velocity
- TV E/e' (Doppler)
- Units:
- View: apical
- Timing: diastole
- Where to measure:
- Pulmonary Artery Acceleration Time (Doppler)
- Units: msec
- View: PSAX
- Timing: systole
- Where to measure: onset of flow to peak velocity
- Mean Longitudinal Strain (STE)
- Units: %
- View: apical
- Timing: systole
- Where to measure:
- Basal Mean Circumferential Strain (STE)
- Units: %
- View: PSAX
- Timing: systole
- Where to measure:
- Mid Mean Circumferential Strain (STE)
- Units: %
- View: PSAX
- Timing: systole
- Where to measure:
- Apical Mean Circumferential Strain (STE)
- Units: %
- View: PSAX
- Timing: systole
- Where to measure:
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