Echocardiography Valve Assessment: Reference Values

Echocardiography · Echo Value

Reference criteria for the echocardiographic assessment and grading of aortic regurgitation. On smaller screens, swipe horizontally within the table to view all columns.

Grading and assessment parameters

	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV =150ml male, =106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (=1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	>65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	>60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	>0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	>60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	>50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

(1) Unless there are other reasons for LV dilation. (2) Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate. (3) PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR. (4) Quantitative parameters can subclassify the moderate regurgitation group.

Parameter	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	<2,5	2,6 - 2,9	3,0 - 4,0	>4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	>40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

	Mild	Moderate		Severe
Structural
Mitral valve morphology	None or mild leaflet abnormality (e.g., mild thickening, calcifications or prolapse, mild tenting)	Moderate leaflet abnormality or moderate tenting		Severe valve lesions (primary: flail leaflet, ruptured papillary muscle, severe retraction, large perforation; secondary: severe tenting, poor leaflet coaptation)
Left ventricle (Size)¹	Usually normal (LVEDV =150ml male, =106ml female)	Normal or mild dilated		Dilated² (LVEDV >150ml male, >106ml female)
Left atrium (Size)¹	Usually normal (LA volume =34ml/m²)	Normal or mild dilated		Dilated²
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, central, narrow, often brief (RegJet/LA area <20%)	Variable		Large central jet (RegJet/LA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration		Large throughout systole (PISAr =1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic		Holosystolic/ dense/ triangular
Semiquantitative
VCW (cm) Vena contracta width	<0,3cm	0,3 - 0,7cm		>0,7cm (>0,8cm)³
Pulmonary vein flow⁴	Systolic dominance (may be blunted in LV dysfunction or AF)	Normal or systolic blunting		Minimal to no systolic flow/ systolic flow reversal
Mitral inflow⁵	A wave dominant (A wave > E wave)	Variable		E wave dominant (E wave >1,2m/s)
Quantitative⁶
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,3	0,3 - 0,39	>0,4
RegVol (ml) Regurgitant volume of mitral regurgitation	<30	30 - 44	45 - 59	>60
RF (%) Regurgitant fraction of mitral valve	<30	30 - 39	40 - 49	>50

Parameter	Mild	Moderate	Severe
MVA (cm²)* Mitral valve area	>1,5	1 - 1,5	<1
meanPG MV (mmHg) Mitral valve mean pressure gradient	<5	5 - 10	>10
RVSP_(SPAP) (mmHg) Right ventricular systolic pressure	<30	30 - 50	>50

	Mild	Moderate	Severe
Pulmonic valve	Normal	Normal or abnormal	Abnormal and may not be visible
Right ventricle (Size)	Normal¹ (RVD1_basal <41mm)	Normal or dilated	Dilated² (RVD1_basal >41mm)
RegJet_length Regurgitant jet length (Nyquist limit 50-70cm/s)	Thin with a narrow origin (usually <10 mm in length)	Intermediate	Broad origin; variable depth of penetration
Ratio_RegJet/PV Ratio regurgitant jet width / pulmonary valve annulus			>70%³
RegJet_density Regurgitant jet density (CW doppler)	Soft	Dense	Dense; early termination of diastolic flow
DT_RegJet Deceleration time of pulmonary regurgitant jet			Short⁴ (<260ms)
PHT_RegJet Pressure half time of pulmonary regurgitant jet			<100ms⁵
PR index⁶ Pulmonary regurgitation index		<0,77	<0,77
PA_{reversal flow} Reversal flow in the branch pulmonary artery			Yes
PV VTI / LVOT VTI⁷ Pulmonic systolic VTI compered to LVOT VTI	Slightly increased	Intermediate	Greatly increased
RF⁸ Regurgitant fraction of pulmonary valve	<20%	20-40%	>40%

Parameter	Mild	Moderate	Severe
Vmax PV (m/s) Maximal (peak) velocity pulmonary valve	<3	3–4	>4
maxPG PV (mmHg) Pulmonary valve maximal pressure gradient	<36	36–64	>64

Echocardiography Valve

Aortic Regurgitation

Grading and assessment parameters

Aortic Stenosis

Severity Classification

Mitral Regurgitation

Severity assessment criteria

Mitral Stenosis

Severity classification

Pulmonary Regurgitation

Severity assessment criteria

Reference illustration

Pulmonary Stenosis

Severity classification

Tricuspid Regurgitation

Severity grading criteria

Tricuspid Stenosis

Echocardiographic reference values

	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Remaining table rows are truncated for brevity in the supplied source.

Variable	Abnormal
meanPG TrV*Mean pressure gradient tricuspidal valve	≥5 mmHg
VTI TrV*Velocity time integral of tricuspid valve (inflow)	>60 cm
PHT TrV*Pressure half time of tricuspidal valve	≥190 ms
TrVA*Tricuspid valve area (continuity equation)	≤1 cm²
RA majorRight atrium major axis dimension	>50 mm
IVC_diameterInferior vena cava diameter	>2.1 cm