Every value carries its source. Where the 2025 guideline generation changed a threshold, the previous value is shown for comparison.
Left ventricle — structure and systolic function
Source: ASE/EACVI 2015 chamber quantification (Lang et al.)
Parameter | Men | Women |
LV end-diastolic diameter | 4.2–5.8 cm | 3.8–5.2 cm |
LV end-diastolic volume index | 34–74 mL/m² | 29–61 mL/m² |
LV end-systolic volume index | 11–31 mL/m² | 8–24 mL/m² |
LV ejection fraction | 52–72% | 54–74% |
Septal / posterior wall thickness | 0.6–1.0 cm | 0.6–0.9 cm |
LV mass index | 49–115 g/m² | 43–95 g/m² |
Relative wall thickness | ≤ 0.42 | ≤ 0.42 |
LVEF severity: mildly reduced 41–51% (men) / 41–53% (women); moderately reduced 30–40%; severely reduced < 30%.
Longitudinal indices: MAPSE ≥ 10 mm; septal s′ ≥ 7 cm/s; GLS ≤ −20% (vendor-dependent); EPSS < 7 mm; dP/dt > 1200 mmHg/s.
Flow
Parameter | Normal | Low-flow threshold |
LVOT diameter | 1.8–2.4 cm | — |
LVOT VTI | 18–22 cm | < 18 cm |
Stroke volume | 60–100 mL | — |
Stroke volume index | 35–65 mL/m² | < 35 mL/m² |
Cardiac index | 2.5–4.0 L/min/m² | < 2.2 L/min/m² |
SVR | 800–1200 dyn·s·cm⁻⁵ | — |
Diastolic function
Source: ASE 2025 (Nagueh et al., JASE 2025;38:537–69)
Mitral annular e′ for impaired relaxation
20–39 y | 40–65 y | > 65 y | |
Septal e′ | < 7 cm/s | < 6 cm/s | < 6 cm/s |
Lateral e′ | < 10 cm/s | < 8 cm/s | < 7 cm/s |
Average e′ | < 9 cm/s | < 7 cm/s | < 6.5 cm/s |
Age-independent cut-offs used in the main algorithm: septal ≤ 6, lateral ≤ 7, average ≤ 6.5 cm/s.
Primary algorithm variables
Variable | Threshold for elevated LAP |
Septal E/e′ | ≥ 15 |
Lateral E/e′ | ≥ 13 |
Average E/e′ | ≥ 14 |
Peak TR velocity | ≥ 2.8 m/s |
PASP | ≥ 35 mmHg |
Secondary variables
Variable | Threshold |
Pulmonary vein S/D | ≤ 0.67 (systolic filling fraction ≤ 40%) |
LA reservoir strain | ≤ 18% |
LAVi | > 34 mL/m² |
IVRT | ≤ 70 ms |
Age-stratified normal ranges (5th–95th percentile)
Measure | 20–39 y | 40–60 y | 60–80 y |
E wave, m/s | 0.54–1.11 | 0.47–1.02 | 0.39–0.92 |
A wave, m/s | 0.24–0.68 | 0.33–0.82 | 0.43–0.97 |
E/A | 0.88–2.73 | 0.69–2.07 | 0.50–1.40 |
Septal e′, cm/s | 7.2–16.4 | 5.7–13.5 | 4.1–10.6 |
Lateral e′, cm/s | 9.9–22.1 | 7.5–17.5 | 5.2–13.0 |
Average E/e′ | 4.0–9.1 | 4.6–11.5 | 5.2–14.0 |
LAVi, mL/m² | 12.1–39.4 | 12.9–38.3 | 13.7–37.1 |
TR velocity, m/s | 1.3–2.7 | 1.5–2.7 | 1.7–2.8 |
LA reservoir strain, % | 29.5–63.2 | 26.8–57.7 | 24.1–52.3 |
Invasive reference
τ > 48 ms; chamber stiffness constant > 0.015; rest mean PCWP > 15 mmHg; rest LVEDP > 16 mmHg; exercise mean PCWP ≥ 25 mmHg.
Right heart
Source: ASE 2025 right heart guideline
Parameter | Normal | Mild | Moderate | Severe |
RV free wall thickness | < 0.5 cm | 0.5–0.7 cm | > 0.7–0.9 cm | > 0.9 cm |
RA volume index | < 33 mL/m² | 33–38 | 39–44 | > 44 mL/m² |
TAPSE | > 1.7 cm | ≤1.7–≥1.3 | ≤1.3–>1.0 | ≤ 1.0 cm |
Tissue Doppler s′ | > 9.5 cm/s | ≤9.5–≥7.2 | ≤7.2–>5.0 | ≤ 5.0 cm/s |
Fractional area change | > 35% | ≤35–>29 | ≤29–>22 | ≤ 22% |
3D RVEF | > 45% | ≤45–<39 | ≤39–≥32 | < 32% |
RV free wall strain (3-seg) | > 20% | ≤20–<15 | <15–≥11 | < 11% |
RV global strain (6-seg) | > 17% | ≤17–>13 | ≤13–>9 | ≤ 9% |
Tissue Doppler RV MPI | < 0.55 | ≥0.55–<0.62 | ≥0.62–<0.70 | ≥ 0.70 |
Pulsed Doppler RV MPI | < 0.40 | ≥0.40–<0.49 | ≥0.49–<0.57 | ≥ 0.57 |
RV–PA coupling: TAPSE/PASP 0.3–0.4 mm/mmHg indicates uncoupling and increased mortality risk.
Acute cor pulmonale (ICU definition): RV/LV end-diastolic area ratio > 0.6 (severe > 1.0) plus septal dyskinesia.
RA pressure estimation from the IVC (spontaneously breathing only)
IVC diameter | Collapse | Estimated RAP |
≤ 2.1 cm | > 50% | 3 mmHg (0–5) |
≤ 2.1 cm | < 50% | 8 mmHg (5–10) |
> 2.1 cm | > 50% | 8 mmHg (5–10) |
> 2.1 cm | < 50% | 15 mmHg (10–20) |
Not valid under positive-pressure ventilation.
Pulmonary haemodynamics
RVOT acceleration time < 105 ms suggests pulmonary hypertension; < 60 ms suggests markedly elevated PVR. The 60/60 sign = AcT < 60 ms with TR gradient ≤ 60 mmHg.
Valve stenosis
Source: EACVI/ASE 2017 focused update; 2025 ESC/EACTS valvular guidelines
Mild | Moderate | Severe | |
Aortic stenosis | |||
Peak velocity, m/s | 2.6–2.9 | 3.0–3.9 | ≥ 4.0 |
Mean gradient, mmHg | < 20 | 20–39 | ≥ 40 |
AVA, cm² | > 1.5 | 1.0–1.5 | ≤ 1.0 |
AVA index, cm²/m² | > 0.85 | 0.60–0.85 | ≤ 0.6 |
Dimensionless index | > 0.50 | 0.25–0.50 | < 0.25 |
Mitral stenosis | |||
MVA, cm² | > 1.5 | 1.0–1.5 | ≤ 1.5 (severe), ≤ 1.0 (very severe) |
Mean gradient, mmHg | < 5 | 5–10 | > 10 |
Tricuspid stenosis | ≥ 5 mmHg mean gradient |
CT aortic valve calcium score supporting severe AS (2025 ESC/EACTS): > 2000 AU in men, > 1200 AU in women.
Valve regurgitation — severe thresholds
Source: ASE 2017 native valvular regurgitation
Vena contracta | EROA | Reg volume | Reg fraction | Supporting | |
Aortic | > 0.6 cm | ≥ 0.3 cm² | ≥ 60 mL | ≥ 50% | PHT < 200 ms; holodiastolic aortic flow reversal (end-diastolic velocity ≥ 20 cm/s); jet/LVOT width > 65% |
Mitral (primary) | ≥ 0.7 cm | ≥ 0.4 cm² | ≥ 60 mL | ≥ 50% | Systolic pulmonary vein flow reversal; dense triangular CW jet |
Mitral (secondary) | ≥ 0.7 cm | ≥ 0.2 cm² | ≥ 30 mL | ≥ 50% | |
Tricuspid | ≥ 0.7 cm | ≥ 0.4 cm² | ≥ 45 mL | — | Hepatic vein systolic flow reversal |
Tricuspid regurgitation — extended grading
Parameter | Mild | Moderate | Severe | Massive | Torrential |
Vena contracta, cm | < 0.3 | 0.3–0.69 | ≥ 0.7 | 1.4–2.0 | ≥ 2.1 |
EROA, cm² | < 0.20 | 0.20–0.39 | ≥ 0.40 | 0.60–0.79 | ≥ 0.80 |
Regurgitant volume, mL | < 30 | 30–44 | ≥ 45 | — | — |
Pulmonic stenosis: mild < 3 m/s (< 36 mmHg); moderate 3–4 m/s (36–64 mmHg); severe > 4 m/s (> 64 mmHg).
Prosthetic valves
Source: Zoghbi WA, et al. ASE 2024 (JASE 2024;37:2–63) — replaces the 2009 document
Prosthetic aortic valve — all types
Parameter | Normal | Possible stenosis | Suggests significant stenosis |
Jet velocity contour | Triangular, early-peaking | Triangular to intermediate | Rounded, symmetric |
Acceleration time, ms | < 80 | 80–100 | > 100 |
AT / LV ejection time | < 0.32 | 0.32–0.37 | > 0.37 |
Peak velocity, m/s | < 3 | 3–4 | ≥ 4 |
Prosthetic aortic valve — SAVR specific
Parameter | Normal | Possible stenosis | Significant stenosis |
Mean gradient, mmHg | < 20 | 20–34 | ≥ 35 |
Doppler velocity index | > 0.35 | 0.25–0.35 | < 0.25 |
EOA | Reference ± 1 SD | 1 SD below reference | 2 SD below reference |
Significant stenosis requires at least one flow-dependent (peak velocity, mean gradient) and one flow-independent (EOA, DVI) parameter.
TAVI (change from post-procedural baseline)
Parameter | Normal | Possible | Significant |
Mean gradient | Change < 10 mmHg | Increase 10–19 mmHg | Increase ≥ 20 mmHg |
DVI | Change < 0.1 or < 20% | Decrease 0.1–0.19 or 20–39% | Decrease ≥ 0.2 or ≥ 40% |
EOA | Change < 0.3 cm² or < 25% | Decrease 0.3–0.59 cm² or 25–49% | Decrease ≥ 0.6 cm² or ≥ 50% |
Prosthetic mitral valve — significant stenosis
Mean gradient > 10 mmHg at a normal heart rate; PHT > 200 ms; DVI (VTI_PrMV/VTI_LVOT) > 2.5; EOA < 1 cm².
Normal mechanical mitral: EOA 2–3 cm², mean gradient 2–3 mmHg (up to 5–6 in small valves). Normal bioprosthetic mitral: EOA 2.2–3.5 cm², mean gradient 3–5 mmHg.
Do not use PHT to calculate prosthetic mitral EOA — it overestimates, particularly in normal valves.
Patient–prosthesis mismatch (indexed EOA, cm²/m²)
Position | Normal | Moderate | Severe |
Aortic, BMI < 30 | > 0.85 | 0.85–0.66 | ≤ 0.65 |
Aortic, BMI ≥ 30 | > 0.70 | 0.70–0.56 | ≤ 0.55 |
Mitral, BMI < 30 | > 1.2 | 1.2–0.91 | ≤ 0.90 |
Mitral, BMI ≥ 30 | > 1.0 | 1.0–0.76 | ≤ 0.75 |
Mechanical occluder opening angles and CT attenuation
Bileaflet 73–90°; monoleaflet 60–80°. Thrombus < 200 HU (lysis most likely < 90 HU); pannus > 200 HU. A 145 HU cutoff separates them with 87.5% sensitivity and 96% specificity.
Fluid responsiveness thresholds
Test | Threshold |
Passive leg raise, ΔVTI | ≥ 10% |
Respiratory ΔV_peak LVOT | ≥ 12% |
End-expiratory occlusion, ΔVTI | ≥ 5% |
Mini fluid challenge (100 mL), ΔVTI | ≥ 6% |
Fluid challenge, ΔSV | ≥ 10–15% |
IVC distensibility (ventilated) | ≥ 18% |
IVC collapsibility (spontaneous) | > 40–50% |
SVC collapsibility (TEE) | ≥ 36% |
Ventriculo-arterial coupling
Parameter | Normal | Decoupling |
Ea | 2–2.5 mmHg/mL | — |
Ees | 2–3 mmHg/mL | — |
Ea/Ees | 0.6–1.0 | > 1.5 (marked > 2.0) |
Tamponade
RA systolic collapse (sensitive; more specific if > ⅓ of the cardiac cycle); RV diastolic collapse (specific); mitral inflow respiratory variation ≥ 25%; tricuspid inflow variation ≥ 40%; plethoric IVC with < 50% collapse; hepatic vein expiratory diastolic flow reversal.
Respiratory variation thresholds are unreliable under positive-pressure ventilation.
Wilkins score for balloon mitral valvuloplasty
Four components (leaflet mobility, leaflet thickening, subvalvular thickening, calcification), each 1–4; total 4–16. Total ≤ 8 predicts a favourable result. Absolute contraindications regardless of score: left atrial thrombus, more than mild mitral regurgitation.