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

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.

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“…Common findings included coronary artery changes in 14 patients (51.8%) (Increased echogenicity, dilatation or fusiform aneurysm formation), valvular involvement in 9 (33.3%) and functional impairment in 9 (33.3%) patients. Valvular regurgitation and functional impairment were classified as “mild” in most cases [ 86 ].…”

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“…In particular, an EF < 60 % was found in 2 NCPHPT patients, in 5 PHPT patients and in 4 controls (p = ns). None of the patients had EF < %, thus lower than a value considered pathological (26).…”

Latest British Society of Echocardiography recommendations for left ventricular ejection fraction categorisation: potential implications and relevance to contemporary heart failure management

“…Moreover, recent evidence points to adverse outcomes even in the setting of ‘supra-normal’ LVEF ( 2 ). As addressed in the recent publication ( 1 ), the latest BSE guidance for LV function categorisation (‘severely impaired’, LVEF ≤35%; ‘impaired’, LVEF 36–49%; ‘borderline low’, LVEF 50–54%; and ‘normal’, LVEF ≥55%) is clearly out of keeping with current guideline documents from international echocardiographic societies (American Society of Echocardiography ( 3 ), European Association of Cardiovascular Imaging ( 4 )) and with those from international cardiology societies in Europe (European Society of Cardiology (ESC) ( 5 )) and North America (American College of Cardiology/American Heart Association ( 6 )). Both the ESC and the AHA define (heart failure with reduced ejection fraction) HFrEF at, or below, 40%.…”

“…Current ESC HF diagnostic thresholds have been conceived on the basis of evidence-based treatment response, with the demonstration in multiple clinical trials of clear benefit from various classes of medication and device therapy for patients with HFrEF (defined as LVEF ≤40%), unlike HFmrEF and HFpEF. While the BSE document cites beneficial impacts upon mortality for angiotensin converting enzyme-inhibitors (ACEi), angiotensin receptor blockers (ARB), betablockers, mineralocorticoid receptor antagonists (MRA), I f channel inhibitors, angiotensin receptor neprilysin inhibitors (ARNI) and device therapies for those with ‘severely impaired’ systolic function, that is, LVEF ≤35% ( 1 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ), some of these same classes of pharmacotherapy also (and importantly) have a well-established and evidence-based extended survival benefit in those HF patients with LVEF <40% (e.g. ACEi ( 21 ), ARBs ( 22 ), MRAs ( 23 ), ARNI ( 17 )).…”

“…We read with interest the recent guideline publication from the British Society of Echocardiography (BSE) relating to normal reference intervals for cardiac dimensions and function for use in echocardiographic practice (1). We commend the authors and the Education Committee for attempting to produce updated guidance taking into account contemporary, prospective data to determine new reference ranges for echocardiographic parameters.…”