Patient
Height, weight, sex, age and heart rate are entered once in the strip above and shared by every tab.
Formulas & sources
- BSA (Mosteller)
BSA = √(height[cm] × weight[kg] / 3600)Mosteller 1987- BSA (DuBois)
BSA = 0.007184 × weight^0.425 × height^0.725DuBois 1916- Body mass index
BMI = weight[kg] / height[m]²
Ventricular volumes & function
Formulas & sources
- Stroke volume
SV = EDV − ESV from the short-axis cine bSSFP stack (Simpson summation of discs); LV and RV contoured at the same end-diastolic and end-systolic phasesSchulz-Menger 2020- Ejection fraction
EF = (EDV − ESV) / EDV × 100; reduced below the sex-specific lower reference limit (mildly 41% to the limit, moderately 30–40%, severely <30%)Schulz-Menger 2020Petersen 2017- Reference ranges (UK Biobank)
Mean ± 2 SD in 800 healthy adults aged 45–74, 1.5 T bSSFP, papillary muscles included in the cavity and excluded from mass, DuBois indexing. Men: LVEDVi 55–115, LVESVi 20–52, LVSVi 29–69 mL/m², LVEF 48–68%, LV mass index 35–71 g/m², RVEDVi 59–127, RVESVi 21–65, RVSVi 32–68 mL/m², RVEF 42–66%. Women: LVEDVi 50–98, LVESVi 17–41, LVSVi 29–61 mL/m², LVEF 51–71%, LV mass index 28–56 g/m², RVEDVi 51–103, RVESVi 15–51, RVSVi 29–61 mL/m², RVEF 46–70%. Labs that exclude papillary muscles from the cavity report higher EF and smaller ESV; see Kawel-Boehm 2020 for younger cohorts and 3 TPetersen 2017Kawel-Boehm 2020- Cardiac output and index
CO = LVSV × HR; CI = CO / BSA. With MR or AR the total LV stroke volume exceeds forward flow — report systemic output from the aortic net flow insteadSchulz-Menger 2020- RV/LV end-diastolic volume ratio
RVEDV / LVEDV; rises with RV volume overload from PR, TR or a left-to-right shunt (bands 1.2 and 1.5 are descriptive, not outcome-derived)Geva 2011- Stroke-volume difference
LVSV − RVSV = (AR + MR) − (TR + PR) − (Qp − Qs); within ±10% in the absence of regurgitation or shunt. For a single regurgitant valve it equals that valve's regurgitant volume (sign shows the side)Cawley 2009Myerson (review) 2012
Valvular regurgitation — AR, MR, PR, TR
Enter ventricular volumes from the cine stack and forward/backward volumes from through-plane phase contrast. AR and PR come straight from the great-artery backward flow; MR and TR from the ventricular stroke volume minus the forward flow. Volumes and flows typed here carry over to the other tabs.
Formulas & sources
- Direct method — AR and PR (phase contrast)
RVol = backward (diastolic) volume through the plane; RF = backward / forward × 100. Plane at the sinotubular junction or just above the aortic valve for AR, in the main PA midway between valve and bifurcation for PR; Venc 10–20% above the peak velocity, no aliasing, background phase-offset correction, retrospective gating covering the whole cycleSchulz-Menger 2020Gatehouse 2010Lotz 2002- Indirect method — MR and TR
MR RVol = LVSV − aortic forward volume; TR RVol = RVSV − pulmonary forward volume; RF = RVol / ventricular stroke volume × 100. Still valid with coexisting AR or PR, because the forward volume includes the blood that later regurgitates; invalid with a VSDCawley 2009Myerson (review) 2012Zoghbi 2017- Direct AV-valve phase contrast (optional)
RVol = backward (systolic) volume across the mitral or tricuspid annulus; RF = backward / forward × 100. Annular motion and eccentric jets make the standard plane unreliable unless valve-tracking or 4D flow is used — the indirect method is preferredGarg 2020Myerson (review) 2012- Combined lesions — identities
LVSV = aortic forward + MR RVol · aortic forward = aortic net + AR RVol · RVSV = pulmonary forward + TR RVol · pulmonary forward = pulmonary net + PR RVol. Hence AR + MR = LVSV − aortic net; TR + PR = RVSV − pulmonary net; LVSV − RVSV = (AR + MR) − (TR + PR) − (Qp − Qs)Cawley 2009Myerson (review) 2012- Grading — ACC/AHA 2020 bands
MR and AR: RVol <30 / 30–59 / ≥60 mL and RF <30 / 30–49 / ≥50% for mild / moderate / severe. The guideline applies the same cut-offs to CMR; echo and CMR grades disagree in a sizeable minority of patientsOtto 2020Zoghbi 2017Uretsky 2015- Grading — CMR outcome-based bands
AR: severe RF >33% or RVol >42 mL (85% progressed to surgery vs 8% below; AUC 0.93); mild <20% (no progression below 20% in the Oxford cohort); moderate in between. MR: severe RF ≥40% or RVol ≥55 mL (progression to symptoms or surgery); RVol ≥50 mL carried excess mortality in asymptomatic primary MR; mild RF <20% (best agreement with echo mild); moderate in betweenMyerson 2012Myerson 2016Penicka 2018Garg 2020- Grading — TR (both schemes)
RVol <30 / 30–44 / ≥45 mL and RF <30 / 30–49 / ≥50% for mild / moderate / severe — mortality-based CMR thresholds in functional TR; ≥45 mL matches the ASE severe cut-offZhan 2020Zoghbi 2017- Grading — PR (both schemes)
RF <20% mild, 20–40% moderate, >40% severe (repaired tetralogy of Fallot convention); no established RVol bands — report the indexed volume. Guideline PVR criteria rely on RF plus RVEDVi, RVESVi, RVEF and symptomsGeva 2011Valente 2014Stout 2018- Internal consistency
Aortic net flow ≈ pulmonary net flow (within ~10%) in the absence of a shunt; LVSV and RVSV agree within ~10% without regurgitation or shunt. Larger discrepancies: uncorrected background phase offset, aliasing, oblique or malpositioned plane, heart-rate change between cine and flow, or inconsistent treatment of papillary muscles/trabeculationsGatehouse 2010Schulz-Menger 2020
Qp:Qs & shunt
Net flows (forward − backward) are used, so AR and PR are already accounted for. Ventricular volumes and independent regurgitant volumes feed the volumetric and hybrid estimates when one great-artery flow is missing or unreliable.
Formulas & sources
- Qp:Qs by phase contrast
Qp = main PA net volume (forward − backward); Qs = ascending aorta net volume; Qp:Qs = Qp / Qs. Flow in L/min = net volume × HR / 1000; index = flow / BSA. Phase-contrast Qp:Qs agrees with invasive oximetry to within ~0.1Beerbaum 2001Schulz-Menger 2020- Regurgitation adjustment
Net (forward − backward) volumes already exclude the blood that returns through a leaking semilunar valve, so PR no longer inflates Qp and AR no longer inflates Qs. The forward-only ratio (PA forward / aortic forward) is shown for comparison; a blank backward volume counts as 0Beerbaum 2001Geva 2011- Volumetric method with regurgitation adjustment
Qp = RVSV − TR RVol − PR RVol; Qs = LVSV − MR RVol − AR RVol (each ventricle's stroke volume minus what goes backward through its two valves). Unadjusted RVSV / LVSV is valid only without regurgitation. The entered regurgitant volumes must be independent measurements (direct phase contrast, or the AR/PR backward flow); deriving MR from LVSV − aortic forward and then subtracting it simply reproduces the phase-contrast ratioCawley 2009Myerson (review) 2012- Hybrid estimates
One circulation from phase contrast and the other from adjusted stroke volume — useful when only one great-artery flow is reliable; the tool picks the net phase-contrast ratio when both flows exist, then a hybrid, then the volumetric ratioBeerbaum 2001- Shunt volume and fraction
Shunt volume = Qp − Qs per beat (× HR for L/min). Shunt fraction = (Qp − Qs) / Qp for left-to-right, (Qs − Qp) / Qs for right-to-leftBeerbaum 2001- Interpretation
Qp:Qs ≥1.5 is hemodynamically significant (ASD/VSD closure threshold with RV enlargement, PA systolic pressure <50% systemic and PVR <1/3 systemic); ≥2.0 large; 0.9–1.1 is within phase-contrast error; <0.9 indicates net right-to-left flow. Between 1.1 and 1.5 check background correction before calling a small shuntStout 2018Baumgartner 2020Gatehouse 2010