FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2187630416> ?p ?o ?g. }

• W2187630416 endingPage "713" @default.
• W2187630416 startingPage "685" @default.
• W2187630416 abstract "Accreditation Statement:The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society of Echocardiography designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. ARDMS and CCI recognize ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The American Society of Echocardiography is committed to ensuring that its educational mission and all sponsored educational programs are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the goals and educational integrity of the activity. While a monetary or professional affiliation with a corporation does not necessarily influence an author's presentation, the Essential Areas and policies of the ACCME require that any relationships that could possibly conflict with the educational value of the activity be resolved prior to publication and disclosed to the audience. Disclosures of faculty and commercial support relationships, if any, have been indicated.Target Audience:This activity is designed for all cardiovascular physicians and cardiac sonographers with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals with a specific interest in cardiac ultrasound will find this activity beneficial.Objectives:Upon completing the reading of this article, the participants will better be able to:1.Describe the conventional two-dimensional acoustic windows required for optimal evaluation of the right heart.2.Describe the echocardiographic parameters required in routine and directed echocardiographic studies, and the views to obtain these parameters for assessing right ventricle (RV) size and function.3.Identify the advantages and disadvantages of each measure or technique as supported by the available literature.4.Recognize which right-sided measures should be included in the standard echocardiographic report.5.Explain the clinical and prognostic significance of right ventricular assessment.Author Disclosure:The authors of this article reported no actual or potential conflicts of interest in relation to this activity. The ASE staff and ASE ACCME/CME reviewers who were involved in the planning and development of this activity reported no actual or potential conflicts of interest: Chelsea Flowers; Rebecca T. Hahn, MD, FASE; Cathy Kerr; Priscilla P. Peters, BA, RDCS, FASE; Rhonda Price; and Cheryl Williams. The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported no actual or potential conflicts of interest in relation to this activity: Deborah A. Agler, RCT, RDCS, FASE; J. Todd Belcik, BS, RDCS, FASE; Renee L. Bess, BS, RDCS, RVT, FASE; Farooq A. Chaudhry, MD, FASE; Robert T. Eberhardt, MD; Benjamin W. Eidem, MD, FASE; Gregory J. Ensing, MD, FASE; Tal Geva, MD, FASE; Kathryn E. Glas, MD, FASE; Sandra Hagen-Ansert, RDCS, RDMS, MS, FASE; Rebecca T. Hahn, MD, FASE; Jeannie Heirs, RDCS; Shunichi Homma, MD; Sanjiv Kaul, MD, FASE; Smadar Kort, MD, FASE; Peg Knoll, RDCS, FASE; Wyman Lai, MD, MPH, FASE; Roberto M. Lang, MD, FASE; Steven Lavine, MD; Steven J. Lester, MD, FASE; Renee Margossian, MD; Victor Mor-Avi, PhD, FASE; Sherif Nagueh, MD, FASE; Alan S. Pearlman, MD, FASE; Patricia A. Pellikka, MD, FASE; Miguel Quiñones, MD, FASE; Brad Roberts, RCS, RDCS; Beverly Smulevitz, BS, RDCS, RVS; Kirk T. Spencer, MD, FASE; J. Geoffrey Stevenson, MD, FASE; Wadea Tarhuni, MD, FASE; James D. Thomas, MD; Neil J. Weissman, MD, FASE; Timothy Woods, MD; and William A. Zoghbi, MD, FASE. The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported a relationship with one or more commercial interests. According to ACCME policy, the ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity. Theodore Abraham, MD, FASE receives honoraria and research grant support from GE Healthcare. Patrick D. Coon, RDCS, FASE is on the speaker's bureau for Philips. Victor G. Davila-Roman, MD, FASE is a consultant for St. Jude Medical, AGA Medical, Medtronic, Boston Scientific Corporation, and Sadra Medical. Elyse Foster, MD receives grant support from Abbott Vascular Structural Heart, EBR Systems, Inc., and Boston Scientific Corporation. Julius M. Gardin, MD, FASE is a consultant/advisor to Arena Pharmaceuticals. Jeffrey C. Hill, BS, RDCS, FASE receives grant/research support from Toshiba America Medical Systems and Philips; is a consultant to Medtronic; and is on the speaker's bureau for Philips. Martin G. Keane, MD, FASE is a consultant/advisor to Pfizer, Inc. and Otsuka Pharmaceuticals. Gilead I. Lancaster, MD, FASE owns stock in, and is a consultant/advisor to, Cardiogal. Jonathan R. Linder, MD, FASE is a consultant/advisor to VisualSonics. Carol C. Mitchell, PhD, RDMS, RDCS, RVT, RT(R), FASE is a speaker and consultant for GE Healthcare. Marti McCulloch, MBA, BS, RDCS, FASE is a speaker for Lantheus and advisor/consultant for Siemens. Tasneem Z. Naqvi, MD, FASE is a consultant/advisor to Edwards Lifesciences and St. Jude Medical, and receives grant support from Medtronic and Actor Medical. Kofo O. Ogunyankin, MD, FASE is on the speaker's bureau for Lantheus. Vera Rigolin, MD, FASE is on the speaker's bureau for Edwards Lifesciences and St. Jude Medical and owns stock in Abbott Labs; Hospira; Johnson and Johnson; and Medtronic. Lawrence G. Rudski, MD receives grant support from Genzyme. Stephen G. Sawada, MD owns stock in GE Healthcare. Alan D. Waggoner, MHS, RDCS is a consultant/advisor for Boston Scientific Corporation and St. Jude Medical, Inc. Estimated Time to Complete This Activity: 1.0 hour Executive Summary 686Overview 688Methodology in the Establishment of Reference Value and Ranges 688Acoustic Windows and Echocardiographic Views of the Right Heart 690Nomenclature of Right Heart Segments and Coronary Supply 690Conventional Two-Dimensional Assessment of the Right Heart 690A.Right Atrium 690RA Pressure 691B.Right Ventricle 692RV Wall Thickness 692RV Linear Dimensions 693C.RVOT 694Fractional Area Change and Volumetric Assessment of the Right Ventricle 696A.RV Area and FAC 696B.Two-Dimensional Volume and EF Estimation 696C.Three-Dimensional Volume Estimation 697The Right Ventricle and Interventricular Septal Morphology 697A.Differential Timing of Geometric Distortion in RV Pressure and Volume Overload States 698Hemodynamic Assessment of the Right Ventricle and Pulmonary Circulation 698A.Systolic Pulmonary Artery Pressure 698B.PA Diastolic Pressure 699C.Mean PA Pressure 699D.Pulmonary Vascular Resistance 699E.Measurement of PA Pressure During Exercise 699Nonvolumetric Assessment of Right Ventricular Function 700A.Global Assessment of RV Systolic Function 700RV dP/dt 700RIMP 700B.Regional Assessment of RV Systolic Function 701TAPSE or Tricuspid Annular Motion (TAM) 701Doppler Tissue Imaging 702Myocardial Acceleration During Isovolumic Contraction 703Regional RV Strain and Strain Rate 704Two-Dimensional Strain 705Summary of Recommendations for the Assessment of Right Ventricular Systolic Function 705Right Ventricular Diastolic Function 705A.RV Diastolic Dysfunction 705B.Measurement of RV Diastolic Function 705C.Effects of Age, Respiration, Heart Rate, and Loading Conditions 706D.Clinical Relevance 706Clinical and Prognostic Significance of Right Ventricular Assessment 706References 708 The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, the systematic assessment of right heart function is not uniformly carried out. This is due partly to the enormous attention given to the evaluation of the left heart, a lack of familiarity with ultrasound techniques that can be used in imaging the right heart, and a paucity of ultrasound studies providing normal reference values of right heart size and function. In all studies, the sonographer and physician should examine the right heart using multiple acoustic windows, and the report should represent an assessment based on qualitative and quantitative parameters. The parameters to be performed and reported should include a measure of right ventricular (RV) size, right atrial (RA) size, RV systolic function (at least one of the following: fractional area change [FAC], S′, and tricuspid annular plane systolic excursion [TAPSE]; with or without RV index of myocardial performance [RIMP]), and systolic pulmonary artery (PA) pressure (SPAP) with estimate of RA pressure on the basis of inferior vena cava (IVC) size and collapse. In many conditions, additional measures such as PA diastolic pressure (PADP) and an assessment of RV diastolic function are indicated. The reference values for these recommended measurements are displayed in Table 1. These reference values are based on values obtained from normal individuals without any histories of heart disease and exclude those with histories of congenital heart disease. Many of the recommended values differ from those published in the previous recommendations for chamber quantification of the American Society of Echocardiography (ASE). The current values are based on larger populations or pooled values from several studies, while several previous normal values were based on a single study. It is important for the interpreting physician to recognize that the values proposed are not indexed to body surface area or height. As a result, it is possible that patients at either extreme may be misclassified as having values outside the reference ranges. The available data are insufficient for the classification of the abnormal categories into mild, moderate, and severe. Interpreters should therefore use their judgment in determining the extent of abnormality observed for any given parameter. As in all studies, it is therefore critical that all information obtained from the echocardiographic examination be considered in the final interpretation.Table 1Summary of reference limits for recommended measures of right heart structure and functionVariableUnitAbnormalIllustrationChamber dimensions RV basal diametercm>4.2Figure 7 RV subcostal wall thicknesscm>0.5Figure 5 RVOT PSAX distal diametercm>2.7Figure 8 RVOT PLAX proximal diametercm>3.3Figure 8 RA major dimensioncm>5.3Figure 3 RA minor dimensioncm>4.4Figure 3 RA end-systolic areacm2>18Figure 3Systolic function TAPSEcm<1.6Figure 17 Pulsed Doppler peak velocity at the annuluscm/s<10Figure 16Pulsed Doppler MPI—>0.40Figure 16Tissue Doppler MPI—>0.55Figure 16, Figure 18FAC (%)%<35Figure 9Diastolic functionE/A ratio—<0.8 or >2.1E/E′ ratio—>6Deceleration time (ms)ms<120FAC, Fractional area change; MPI, myocardial performance index; PLAX, parasternal long-axis; PSAX, parasternal short-axis; RA, right atrium; RV, right ventricle; RVD, right ventricular diameter; RVOT, right ventricular outflow tract; TAPSE, tricuspid annular plane systolic excursion. Open table in a new tab FAC, Fractional area change; MPI, myocardial performance index; PLAX, parasternal long-axis; PSAX, parasternal short-axis; RA, right atrium; RV, right ventricle; RVD, right ventricular diameter; RVOT, right ventricular outflow tract; TAPSE, tricuspid annular plane systolic excursion. Apical 4-chamber, modified apical 4-chamber, left parasternal long-axis (PLAX) and parasternal short-axis (PSAX), left parasternal RV inflow, and subcostal views provide images for the comprehensive assessment of RV systolic and diastolic function and RV systolic pressure (RVSP). rv dimension. RV dimension is best estimated at end-diastole from a right ventricle–focused apical 4-chamber view. Care should be taken to obtain the image demonstrating the maximum diameter of the right ventricle without foreshortening (Figure 6). This can be accomplished by making sure that the crux and apex of the heart are in view (Figure 7). Diameter > 42 mm at the base and > 35 mm at the mid level indicates RV dilatation. Similarly, longitudinal dimension > 86 mm indicates RV enlargement.Figure 1Views used to perform comprehensive evaluation of the right heart. Each view is accompanied by uses, advantages, and limitations of that particular view. Ao, aorta; ASD, atrial septal defect; CS, coronary sinus; EF, ejection fraction; EV, Eustachian valve; LA, left atrium; LV, left ventricle; MV, mitral valve; PA, pulmonary artery; PFO, patent foramen ovale; PM, papillary muscle; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; U/S, ultrasound.View Large Image Figure ViewerDownload Hi-res image Download (PPT) ra dimension. The apical 4-chamber view allows estimation of the RA dimensions (Figure 3). RA area > 18 cm2, RA length (referred to as the major dimension) > 53 mm, and RA diameter (otherwise known as the minor dimension) > 44 mm indicate at end-diastole RA enlargement.Figure 3Tracing of the right atrium (RA) is performed from the plane of the tricuspid annulus (TA), along the interatrial septum (IAS), superior and anterolateral walls of the RA. The right atrial major dimension is represented by the green line from the TA center to the superior right atrial wall, and the right atrial minor dimension is represented by the blue line from the anterolateral wall to the IAS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Inferior vena cava (IVC) view. Measurement of the IVC. The diameter (solid line) is measured perpendicular to the long axis of the IVC at end-expiration, just proximal to the junction of the hepatic veins that lie approximately 0.5 to 3.0 cm proximal to the ostium of the right atrium (RA).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 5Measurement of end-diastolic right ventricular wall thickness. (A) Subcostal 2-dimensional image of right ventricular wall. (B) Zoom of region outlined in (A) with right ventricular wall thickness indicated by arrows. (C) M-mode image corresponding to arrows in (B). (D) Zoom of region outlined in (C) with arrows indicating wall thickness at end-diastole.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 6Diagram showing the recommended apical 4-chamber (A4C) view with focus on the right ventricle (RV) (1∗) and the sensitivity of right ventricular size with angular change (2,3) despite similar size and appearance of the left ventricle (LV). The lines of intersection of the A4C planes (1∗,2,3) with a mid left ventricular short-axis are shown above and corresponding A4C views below.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 7Diagram (left) and corresponding echocardiographic apical 4-chamber image (right) showing the right ventricular (RV) basal (RVD1) and mid cavity (RVD2) RV minor dimensions and the RV longitudinal dimension (RVD3). The transducer is adjusted to focus on the RV chamber, with the goal of maximizing RV chamber size. The RV free wall is better seen in this view, also facilitating measurements for fractional area change. Reproduced from J Am Soc Echocardiogr.1Lang R.M. Bierig M. Devereux R.B. Flachskampf F.A. Foster E. Pellikka P.A. et al.Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463Abstract Full Text Full Text PDF PubMed Scopus (3836) Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 8Measurement of right ventricular outflow tract (RVOT) dimensions at the proximal or subvalvular level (RVOT-Prox) and at the distal or pulmonic valve (RVOT-Distal) in the (A) parasternal long-axis RVOT anterior portion view, (B) basal parasternal short-axis view, and (C) parasternal short-axis of pulmonary bifurcation view. PA, Pulmonary artery dimension between valve and the bifurcation point.View Large Image Figure ViewerDownload Hi-res image Download (PPT) rv outflow tract (rvot) dimension. The left PSAX view demonstrating RVOT at the level of the pulmonic valve yields the “distal diameter” (Figure 8C), while the left PLAX view allows for the measurement of the proximal portion of the RVOT, also referred to as “proximal diameter” (Figure 8A). Diameter > 27 mm at end-diastole at the level of pulmonary valve insertion (“distal diameter”) indicates RVOT dilatation. rv wall thickness. RV wall thickness is measured in diastole, preferably from the subcostal view, using either M-mode or two-dimensional (2D) imaging (Figure 5). Alternatively, the left parasternal view is also used for measuring RV wall thickness. Thickness > 5 mm indicates RV hypertrophy (RVH) and may suggest RV pressure overload in the absence of other pathologies. ivc dimension. The subcostal view permits imaging and measurement of the IVC and also assesses inspiratory collapsibility. IVC diameter should be measured just proximal to the entrance of hepatic veins (Figure 4). For simplicity and uniformity of reporting, specific values of RA pressure, rather than ranges, should be used in the determination of SPAP. IVC diameter ≤ 2.1 cm that collapses >50% with a sniff suggests normal RA pressure of 3 mm Hg (range, 0-5 mm Hg), whereas IVC diameter > 2.1 cm that collapses < 50% with a sniff suggests high RA pressure of 15 mm Hg (range, 10-20 mm Hg). In scenarios in which IVC diameter and collapse do not fit this paradigm, an intermediate value of 8 mm Hg (range, 5-10 mm Hg) may be used or, preferably, other indices of RA pressure should be integrated to downgrade or upgrade to the normal or high values of RA pressure. It should be noted that in normal young athletes, the IVC may be dilated in the presence of normal pressure. In addition, the IVC is commonly dilated and may not collapse in patients on ventilators, so it should not be used in such cases to estimate RA pressure. RV systolic function has been evaluated using several parameters, namely, RIMP, TAPSE, 2D RV FAC, 2D RV ejection fraction (EF), three-dimensional (3D) RV EF, tissue Doppler–derived tricuspid lateral annular systolic velocity (S′), and longitudinal strain and strain rate. Among them, more studies have demonstrated the clinical utility and value of RIMP, TAPSE, 2D FAC, and S′ of the tricuspid annulus. Although 3D RV EF seems to be more reliable with fewer reproducibility errors, there are insufficient data demonstrating its clinical value at present. RIMP provides an index of global RV function. RIMP > 0.40 by pulsed Doppler and > 0.55 by tissue Doppler indicates RV dysfunction. By measuring the isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and ejection time (ET) indices from the pulsed tissue Doppler velocity of the lateral tricuspid annulus, one avoids errors related to variability in the heart rate. RIMP can be falsely low in conditions associated with elevated RA pressures, which will decrease the IVRT. TAPSE is easily obtainable and is a measure of RV longitudinal function. TAPSE < 16 mm indicates RV systolic dysfunction. It is measured from the tricuspid lateral annulus. Although it measures longitudinal function, it has shown good correlation with techniques estimating RV global systolic function, such as radionuclide-derived RV EF, 2D RV FAC, and 2D RV EF. Two-dimensional FAC (as a percentage) provides an estimate of RV systolic function. Two-dimensional FAC < 35% indicates RV systolic dysfunction. It is important to make sure that the entire right ventricle is in the view, including the apex and the lateral wall in both systole and diastole. Care must be taken to exclude trabeculations while tracing the RV area. S′ is easy to measure, reliable and reproducible. S′ velocity < 10 cm/s indicates RV systolic dysfunction. S′ velocity has been shown to correlate well with other measures of global RV systolic function. It is important to keep the basal segment and the annulus aligned with the Doppler cursor to avoid errors. Assessment of RV diastolic function is carried out by pulsed Doppler of the tricuspid inflow, tissue Doppler of the lateral tricuspid annulus, pulsed Doppler of the hepatic vein, and measurements of IVC size and collapsibility. Various parameters with their upper and lower reference ranges are shown in Table 1. Among them, the E/A ratio, deceleration time, the E/e′ ratio, and RA size are recommended. Note that these parameters should be obtained at end-expiration during quiet breathing or as an average of ≥5 consecutive beats and that they may not be valid in the presence of significant tricuspid regurgitation (TR). grading of rv diastolic dysfunction. A tricuspid E/A ratio < 0.8 suggests impaired relaxation, a tricuspid E/A ratio of 0.8 to 2.1 with an E/e′ ratio > 6 or diastolic flow predominance in the hepatic veins suggests pseudonormal filling, and a tricuspid E/A ratio > 2.1 with deceleration time < 120 ms suggests restrictive filling. TR velocity reliably permits estimation of RVSP with the addition of RA pressure, assuming no significant RVOT obstruction. It is recommended to use the RA pressure estimated from IVC and its collapsibility, rather than arbitrarily assigning a fixed RA pressure. In general, TR velocity > 2.8 to 2.9 m/s, corresponding to SPAP of approximately 36 mm Hg, assuming an RA pressure of 3 to 5 mm Hg, indicates elevated RV systolic and PA pressure. SPAP may increase, however, with age and in obesity. In addition, SPAP is also related to stroke volume and systemic blood pressure. Elevated SPAP may not always indicate increased pulmonary vascular resistance (PVR). In general, those who have elevated SPAP should be carefully evaluated. It is important to take into consideration that the RV diastolic function parameters and SPAP are influenced by the systolic and diastolic function of the left heart. PA pressure should be reported along with systemic blood pressure or mean arterial pressure. Because echocardiography is the first test used in the evaluation of patients presenting with cardiovascular symptoms, it is important to provide basic assessment of right heart structure and function, in addition to left heart parameters. In those with established right heart failure or pulmonary hypertension (PH), further detailed assessment using other parameters such as PVR, can be carried out. The right ventricle has long been neglected, yet it is RV function that is strongly associated with clinical outcomes in many conditions. Although the left ventricle has been studied extensively, with established normal values for dimensions, volumes, mass, and function, measures of RV size and function are lacking. The relatively predictable left ventricular (LV) shape and standardized imaging planes have helped establish norms in LV assessment. There are, however, limited data regarding the normal dimensions of the right ventricle, in part because of its complex shape. The right ventricle is composed of 3 distinct portions: the smooth muscular inflow (body), the outflow region, and the trabecular apical region. Volumetric quantification of RV function is challenging because of the many assumptions required. As a result, many physicians rely on visual estimation to assess RV size and function. The basics of RV dimensions and function were included as part of the ASE and European Association of Echocardiography recommendations for chamber quantification published in 2005.1Lang R.M. Bierig M. Devereux R.B. Flachskampf F.A. Foster E. Pellikka P.A. et al.Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463Abstract Full Text Full Text PDF PubMed Scopus (3836) Google Scholar This document, however, focused on the left heart, with only a small section covering the right-sided chambers. Since this publication, there have been significant advances in the echocardiographic assessment of the right heart. In addition, there is a need for greater dissemination of details regarding the standardization of the RV echocardiographic examination. These guidelines are to be viewed as a starting point to establish a standard uniform method for obtaining right heart images for assessing RV size and function and as an impetus for the development of databases to refine the normal values. This guidelines document is not intended to serve as a detailed description of pathology affecting the right heart, although the document contains many references that describe RV pathologic conditions and how they affect the measurements described. 1.Describe the acoustic windows and echocardiographic views required for optimal evaluation of the right heart.2.Describe the echocardiographic parameters required in routine and directed echocardiographic studies and the views to obtain these parameters for assessing RV size and function.3.Critically assess the available data from the literature and present the advantages and disadvantages of each measure or technique.4.Recommend which right-sided measures should be included in the standard echocardiographic report.5.Provide revised reference values for right-sided measures with cutoff limits representing 95% confidence intervals based on the current available literature. An extensive systematic literature search was performed to identify all studies reporting echocardiographic right heart measurements in normal subjects. These encompassed studies reporting normal reference values and, more commonly, studies reporting right heart size and function in patients with specific disease states (eg, chronic obstructive pulmonary disease) versus normal healthy controls. In the latter, only the control group was used in the determination of normal values. It is important to note that these reference values are based on values obtained from normal individuals without any history of heart disease and exclude those with history of congenital heart disease. For each measurement, the mean value and standard deviation (SD) were extracted, ensuring that the technique used to obtain the measurement was comparable between studies. Individual patient data were not available and therefore not extracted. The mean values and SDs were pooled and weighted to take into account study size and interstudy variability, as is typical for random-effects meta-analyses. The meta-analysis yielded a pooled estimate for the mean value, a pooled estimate for the lower reference value (ie, mean value − 2 SDs), and a pooled estimate for the upper reference value (ie, mean value + 2 SDs). In addition, 95% confidence intervals surrounding the mean and upper and lower reference values were calculated to add further insight into the robustness of the reference values. Reference values were reviewed by the writing group members to ensure that they were in accordance with clinical experience, and select measures were further discussed with outside experts. Our document therefore reports the mean values along with the upper and lower reference values in a normal population, each with 95% confidence intervals. Because patient-level data were not available, it is not possible to define cutoffs for body surface area, gender, or ethnicity. As a result, a value may fall within the 95% confidence interval for a given patient, but this value may still be abnormal for that patient, or vice versa. Similarly, patient-level data were not available to divide the abnormal categories into mild, moderate, and severe degrees of abnormality. Interpreters should therefore use their judgment in determining the extent of abnormality observed for any given parameter. In the rare situation in which insufficient data were available to perform the analysis described above, but the committee believed that guidelines were required (eg, estimation of RA pressure), current data were reviewed and a consensus put forth on the basis of the best available data. Many of the values provided in this document are significantly diff" @default.
• W2187630416 created "2016-06-24" @default.
• W2187630416 creator A5006847974 @default.
• W2187630416 creator A5009859448 @default.
• W2187630416 creator A5031678800 @default.
• W2187630416 creator A5043014936 @default.
• W2187630416 creator A5044110607 @default.
• W2187630416 creator A5044541484 @default.
• W2187630416 creator A5054227809 @default.
• W2187630416 creator A5054830306 @default.
• W2187630416 creator A5072402610 @default.
• W2187630416 date "2010-07-01" @default.
• W2187630416 modified "2023-10-16" @default.
• W2187630416 title "Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography" @default.
• W2187630416 cites W1504285726 @default.
• W2187630416 cites W154315124 @default.
• W2187630416 cites W1625040375 @default.
• W2187630416 cites W1874422815 @default.
• W2187630416 cites W1966207863 @default.
• W2187630416 cites W1966693612 @default.
• W2187630416 cites W1966916441 @default.
• W2187630416 cites W1967796855 @default.
• W2187630416 cites W1969591792 @default.
• W2187630416 cites W1969847513 @default.
• W2187630416 cites W1971048659 @default.
• W2187630416 cites W1971910531 @default.
• W2187630416 cites W1973114382 @default.
• W2187630416 cites W1973820150 @default.
• W2187630416 cites W1975039732 @default.
• W2187630416 cites W1975607289 @default.
• W2187630416 cites W1976471618 @default.
• W2187630416 cites W1976726694 @default.
• W2187630416 cites W1981184070 @default.
• W2187630416 cites W1981662628 @default.
• W2187630416 cites W1982042679 @default.
• W2187630416 cites W1983032299 @default.
• W2187630416 cites W1984444337 @default.
• W2187630416 cites W1984559182 @default.
• W2187630416 cites W1985836748 @default.
• W2187630416 cites W1986286083 @default.
• W2187630416 cites W1986561626 @default.
• W2187630416 cites W1986787858 @default.
• W2187630416 cites W1988465382 @default.
• W2187630416 cites W1991176626 @default.
• W2187630416 cites W1992540987 @default.
• W2187630416 cites W1992659525 @default.
• W2187630416 cites W1993041466 @default.
• W2187630416 cites W1993334257 @default.
• W2187630416 cites W1993400189 @default.
• W2187630416 cites W1993415548 @default.
• W2187630416 cites W1994000510 @default.
• W2187630416 cites W1994057947 @default.
• W2187630416 cites W1994162332 @default.
• W2187630416 cites W1994316495 @default.
• W2187630416 cites W1994586354 @default.
• W2187630416 cites W1995786920 @default.
• W2187630416 cites W1997811042 @default.
• W2187630416 cites W2000211944 @default.
• W2187630416 cites W2001385061 @default.
• W2187630416 cites W2001535966 @default.
• W2187630416 cites W2001556481 @default.
• W2187630416 cites W2001674341 @default.
• W2187630416 cites W2003030784 @default.
• W2187630416 cites W2003399513 @default.
• W2187630416 cites W2005320583 @default.
• W2187630416 cites W2005549235 @default.
• W2187630416 cites W2006290430 @default.
• W2187630416 cites W2006464513 @default.
• W2187630416 cites W2006507625 @default.
• W2187630416 cites W2008950736 @default.
• W2187630416 cites W2010819126 @default.
• W2187630416 cites W2011943289 @default.
• W2187630416 cites W2013025923 @default.
• W2187630416 cites W2013054691 @default.
• W2187630416 cites W2014244334 @default.
• W2187630416 cites W2018224764 @default.
• W2187630416 cites W2019860698 @default.
• W2187630416 cites W2022199630 @default.
• W2187630416 cites W2023100003 @default.
• W2187630416 cites W2024224851 @default.
• W2187630416 cites W2024381337 @default.
• W2187630416 cites W2024596192 @default.
• W2187630416 cites W2024826486 @default.
• W2187630416 cites W2025384111 @default.
• W2187630416 cites W2026939372 @default.
• W2187630416 cites W2027267084 @default.
• W2187630416 cites W2028441091 @default.
• W2187630416 cites W2029596597 @default.
• W2187630416 cites W2029734761 @default.
• W2187630416 cites W2030683556 @default.
• W2187630416 cites W2030788154 @default.
• W2187630416 cites W2031087786 @default.
• W2187630416 cites W2032355049 @default.
• W2187630416 cites W2032825781 @default.
• W2187630416 cites W2033039042 @default.
• W2187630416 cites W2034052043 @default.
• W2187630416 cites W2035384054 @default.
• W2187630416 cites W2036582587 @default.

• next