Normal Reference Intervals for Cardiac Dimensions and Function for Use in Echocardiographic Practice: A Guideline from the British Society of Echocardiography

TLDR

The guideline updates reference limits for echocardiographic parameters, addressing the rationale for change, defining how intervals were established, noting current limitations, and highlighting the importance of interpreting measurements within clinical context and conceptual changes to cardiac assessment. The guideline aims to provide updated reference limits for echocardiographic parameters to be used in clinical practice. The guideline defines reference intervals by discussing how they were derived, outlines current limitations, and updates each echo parameter—including LV dimensions, volumes, ejection fraction, LA size, right heart parameters, aortic dimensions, and tissue Doppler imaging. The guideline introduces new terminology for left ventricular function and left atrial size, proposes a new approach to aortic root and right heart assessment, clarifies optimal methodology for LA size, and recommends using indexed measures over absolute values for chamber sizing.

Abstract

Abstract This guideline presents reference limits for use in echocardiographic practice, updating previous guidance from the British Society of Echocardiography. The rationale for change is discussed, in addition to how the reference intervals were defined and the current limitations to their use. The importance of interpretation of echocardiographic parameters within the clinical context is explored, as is grading of abnormality. Each of the following echo parameters are discussed and updated in turn: left ventricular linear dimensions and LV mass; left ventricular volumes; left ventricular ejection fraction; left atrial size; right heart parameters; aortic dimensions; and tissue Doppler imaging. There are several important conceptual changes to the assessment of the heart’s structure and function within this guideline. New terminology for left ventricular function and left atrial size are introduced. The British Society of Echocardiography has advocated a new approach to the assessment of the aortic root, the right heart, and clarified the optimal methodology for assessment of LA size. The British Society of Echocardiography has emphasized a preference to use, where feasible, indexed measures over absolute values for any chamber size.