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
LV size, mass & function
Formulas & sources
- LV mass (ASE cube formula)
LV mass = 0.8 × 1.04 × [(IVSd + LVIDd + PWd)³ − LVIDd³] + 0.6 g, dimensions in cmDevereux 1986Lang 2015- LV mass index
LVMI = LV mass / BSA; abnormal >95 g/m² (women), >115 g/m² (men)Lang 2015- LV mass / height²·⁷
LV mass / height[m]^2.7; LVH >47 g/m²·⁷ (women), >50 g/m²·⁷ (men)Williams 2018- Relative wall thickness
RWT = 2 × PWd / LVIDd; increased >0.42Lang 2015- LV geometry
Normal mass & RWT ≤0.42: normal · normal mass & RWT >0.42: concentric remodeling · ↑mass & RWT >0.42: concentric hypertrophy · ↑mass & RWT ≤0.42: eccentric hypertrophyLang 2015- LVIDd normal ranges
LVIDd 42–58 mm (men), 38–52 mm (women); LVIDd/BSA 2.2–3.0 cm/m² (men), 2.3–3.1 cm/m² (women)Lang 2015- Ejection fraction
EF = (EDV − ESV) / EDV; normal 52–72% (men), 54–74% (women); mildly 41–51/53%, moderately 30–40%, severely <30%Lang 2015- Indexed volumes
EDV/BSA 34–74 mL/m² (men), 29–61 (women); ESV/BSA 11–31 (men), 8–24 (women)Lang 2015- Teichholz volumes
V = 7.0 / (2.4 + D) × D³, D in cm; EF from the derived EDV/ESVTeichholz 1976Lang 2015- Fractional shortening
FS = (LVIDd − LVIDs) / LVIDd; normal 25–43% (men), 27–45% (women)Lang 2015
Stroke volume, cardiac output & shunt
Formulas & sources
- Outflow tract area
CSA = π × (diameter / 2)²Quinones 2002- Stroke volume
SV = CSA × VTIQuinones 2002- Stroke volume index
SVI = SV / BSA; low flow <35 mL/m²Baumgartner 2017- Cardiac output / index
CO = SV × HR; CI = CO / BSAQuinones 2002- Shunt ratio
Qp:Qs = (RVOT CSA × RVOT VTI) / (LVOT CSA × LVOT VTI); ≥1.5 significantQuinones 2002Stout 2018
Aortic stenosis & prosthetic AV
Formulas & sources
- Simplified Bernoulli
ΔP = 4 × V²Baumgartner 2009- Bernoulli with proximal velocity
ΔP = 4 × (V₂² − V₁²)Baumgartner 2009- AVA by continuity (VTI)
AVA = CSA(LVOT) × VTI(LVOT) / VTI(AV)Baumgartner 2017- AVA by continuity (peak velocity)
AVA = CSA(LVOT) × V(LVOT) / V(AV)Baumgartner 2017- Indexed AVA
AVAi = AVA / BSA; severe <0.6 cm²/m²Baumgartner 2017- Dimensionless index
DVI = VTI(LVOT) / VTI(AV) (or velocity ratio); severe <0.25Baumgartner 2017Baumgartner 2009- AS grading
Mild: Vmax 2.6–2.9 m/s, mean ΔP <20, AVA >1.5 · Moderate: 3.0–3.9, 20–39, 1.0–1.5 · Severe: ≥4.0, ≥40, <1.0 (AVAi <0.6, SVI <35 defines low flow) · Very severe: ≥5.0 m/s or ≥60 mmHgBaumgartner 2017Otto 2020- Prosthetic AV obstruction
Normal / possible / significant: Vmax <3 / 3–4 / >4 m/s · mean ΔP <20 / 20–35 / >35 · DVI ≥0.30 / 0.25–0.29 / <0.25 · EOA >1.2 / 0.8–1.2 / <0.8 cm² · AT <80 / 80–100 / >100 msZoghbi 2009Lancellotti 2016- Patient–prosthesis mismatch
Aortic: iEOA >0.85 none, 0.66–0.85 moderate, ≤0.65 severe · Mitral: >1.2 none, 0.9–1.2 moderate, <0.9 severe (cm²/m²)Lancellotti 2016Pibarot 2009
Mitral stenosis & prosthetic MV
Formulas & sources
- MVA by pressure half-time
MVA = 220 / PHT[ms]Hatle 1979Baumgartner 2009- PHT from deceleration time
PHT = 0.29 × DTBaumgartner 2009- MVA by continuity
MVA = CSA(LVOT) × VTI(LVOT) / VTI(MV)Baumgartner 2009- MVA by PISA
MVA = 2π r² × Va / Vmax × (α / 180°)Baumgartner 2009- MS grading
ASE/EAE 2009: MVA >1.5 / 1.0–1.5 / <1.0 cm², mean ΔP <5 / 5–10 / >10 mmHg, PASP <30 / 30–50 / >50 for mild / moderate / severe · ACC/AHA 2020: severe = MVA ≤1.5 cm², very severe ≤1.0 cm²Baumgartner 2009Otto 2020- Prosthetic MV obstruction
Normal / possible / significant: peak E <1.9 / 1.9–2.5 / ≥2.5 m/s · mean ΔP ≤5 / 6–10 / >10 mmHg · VTI(MV)/VTI(LVOT) <2.2 / 2.2–2.5 / >2.5 · EOA ≥2.0 / 1–2 / <1 cm² · PHT <130 / 130–200 / >200 msZoghbi 2009Lancellotti 2016- Patient–prosthesis mismatch
Mitral iEOA >1.2 none, 0.9–1.2 moderate, <0.9 severe (cm²/m²)Lancellotti 2016Pibarot 2009
Regurgitation — MR, AR, TR
Formulas & sources
- Effective regurgitant orifice area (PISA)
EROA = 2π r² × Va / Vmax × (α / 180°); r in cm, Va and Vmax in cm/sZoghbi 2017- Regurgitant volume (PISA)
RVol = EROA × VTI(regurgitant jet)Zoghbi 2017- Regurgitant fraction
MR: RF = RVol / (LVOT SV + RVol) · AR: RF = RVol / LVOT SV · TR: RF = RVol / (RVOT SV + RVol)Zoghbi 2017- Volumetric method
MR: RVol = SV(mitral annulus) − SV(LVOT) · AR: RVol = SV(LVOT) − SV(mitral or RVOT); RF = RVol / total SV through the regurgitant valveZoghbi 2017- Stroke volume
SV = π (d/2)² × VTIQuinones 2002- Grading
MR: EROA <0.20 / 0.20–0.39 / ≥0.40 cm², RVol <30 / 30–59 / ≥60 mL, RF <30 / 30–49 / ≥50% · AR: EROA <0.10 / 0.10–0.29 / ≥0.30, RVol and RF as MR · TR: EROA ≥0.40 cm² and RVol ≥45 mL severeZoghbi 2017- AR pressure half-time
PHT >500 ms mild, 200–500 intermediate, <200 ms severeZoghbi 2017- LV dP/dt from the MR jet
dP/dt = 32 mmHg / Δt(1→3 m/s); normal >1200 mmHg/sBargiggia 1989
Right heart & pulmonary pressures
Formulas & sources
- RA pressure from the IVC
IVC ≤2.1 cm and collapse >50% → 3 mmHg (0–5) · IVC >2.1 cm and collapse <50% → 15 mmHg (10–20) · otherwise 8 mmHg (5–10)Rudski 2010Lang 2015- RV systolic pressure
RVSP = 4 × TRV² + RAPRudski 2010- Echo probability of pulmonary hypertension
TR velocity ≤2.8 m/s low, 2.9–3.4 intermediate, >3.4 high (modified by other echo signs)Humbert 2022- Mean PAP from PASP
mPAP = 0.61 × PASP + 2Chemla 2004- Mean PAP from PR
mPAP = 4 × V(PR peak)² + RAPRudski 2010- PA diastolic pressure
PADP = 4 × V(PR end-diastolic)² + RAPRudski 2010- Mean PAP from acceleration time
mPAP = 79 − 0.45 × AT (Mahan); if AT <120 ms, mPAP = 90 − 0.62 × AT (Dabestani)Dabestani 1987Rudski 2010- Pulmonary vascular resistance
PVR [WU] = 10 × TRV / VTI(RVOT) + 0.16; ratio >0.175 suggests PVR >2 WUAbbas 2003- RV fractional area change
FAC = (EDA − ESA) / EDA; abnormal <35%Rudski 2010Lang 2015- RV longitudinal function
TAPSE <17 mm and S′ <9.5 cm/s abnormalLang 2015- RV myocardial performance (Tei) index
MPI = (TCO − ET) / ET; abnormal >0.43 (pulsed Doppler) or >0.54 (tissue Doppler)Tei 1995Rudski 2010
Diastolic function & LA pressure
Formulas & sources
- E/A ratio
E/A = mitral E / mitral ANagueh 2025- E/e′
e′ avg = (septal + lateral) / 2; increased E/e′: septal ≥15, lateral ≥13, average ≥14Nagueh 2025- Reduced e′ (Step 1)
Fixed: septal ≤6, lateral ≤7, average ≤6.5 cm/s · Age-specific (Table 6): 20–39 y <7 / <10 / <9; 40–65 y <6 / <8 / <7; >65 y <6 / <7 / <6.5 cm/sNagueh 2025- Diagnosing diastolic dysfunction, normal EF (2025 Figure 2)
Step 1: e′ reduced? · Step 2 markers: average E/e′ >14, LARS ≤18%, E/A ≤0.8 or ≥2, LAVi >34 mL/m², LV mass index >95 (women) / >115 (men) g/m². Dysfunction present if e′ reduced + ≥1 marker, or e′ preserved + ≥2 markersNagueh 2025- Mean LAP in sinus rhythm (2025 Figure 3)
Primary: reduced e′; E/e′ septal ≥15 / lateral ≥13 / average ≥14; TR ≥2.8 m/s or PASP ≥35 mmHg. All three abnormal → elevated LAP. Reduced e′ only: E/A ≤0.8 → grade 1, normal LAP; E/A >0.8 → additional variables. Only E/e′, only TR/PASP, or any two abnormal → additional variables: LARS ≤18%, PV S/D ≤0.67, LAVi >34 mL/m², IVRT ≤70 ms — any one present → elevated LAP; none → LAP likely normal. Supplemental when primary unreliable: PR end-diastolic velocity ≥2 m/s, PADP ≥16 mmHg, mitral L-wave ≥50 cm/s, Ar−A >30 ms, E/A fall ≥50% with ValsalvaNagueh 2025- Grading (2025)
Grade 1: reduced e′ with normal LAP · Grade 2: elevated LAP with E/A <2 · Grade 3: elevated LAP with E/A ≥2 (3a reversible with Valsalva, 3b not). Symptomatic grade 1 or normal resting LAP → diastolic exercise echoNagueh 2025- Atrial fibrillation (2025)
Primary (average ≥5 beats): mitral E ≥100 cm/s, septal E/e′ >11, TR >2.8 m/s or PASP >35 mmHg, E deceleration time ≤160 ms. ≥3 abnormal → elevated LAP; ≤1 → normal; exactly 2 → secondary criteria LARS <18%, PV S/D <1, BMI >30: ≥2 present → elevated, none → normal, otherwise indeterminateNagueh 2025- LA reservoir strain
≥23% normal; 19–22% below normal but not diagnostic; ≤18% supports elevated LAP (high specificity, lower sensitivity with normal EF)Nagueh 2025- Pulmonary vein S/D
S/D = peak systolic / peak diastolic velocity; ≤0.67 supports elevated LAP (most reliable with reduced EF)Nagueh 2025- Isovolumic relaxation time
IVRT ≤70 ms supports elevated LAP in sinus rhythmNagueh 2025- LA volume index
LAVI = LA volume / BSA; enlarged >34 mL/m² (exclude athletes, anemia, AF/flutter, mitral valve disease as causes)Lang 2015Nagueh 2025- LV mass index as a Step-2 marker
ASE cube formula from the LV tab dimensions; >95 g/m² (women), >115 g/m² (men) after excluding athletic hypertrophyNagueh 2025Lang 2015- Diastolic function with normal EF (2016)
Criteria: E/e′ avg >14 · septal e′ <7 or lateral e′ <10 cm/s · TR velocity >2.8 m/s · LAVI >34 mL/m². >50% positive = dysfunction; 50% = indeterminate; <50% = normalNagueh 2016- Grading / filling pressure (2016)
E/A ≤0.8 with E ≤50 cm/s → grade I (normal LAP) · E/A ≥2 → grade III (↑LAP) · otherwise count E/e′ avg >14, TR >2.8 m/s, LAVI >34: ≥2 of 3 positive → grade II (↑LAP); ≤1 of 3 → grade I; with only 2 available, 1 positive → indeterminateNagueh 2016- Estimated PCWP
PCWP = 1.24 × E/e′ + 1.9Nagueh 1997
Aortic root & ascending aorta
Formulas & sources
- Indexed diameters
diameter / BSA and diameter / heightLang 2015Goldstein 2015- Absolute size thresholds
Sporadic root/ascending aneurysm: repair at ≥5.5 cm; ≥5.0 cm reasonable with risk factors or at experienced centers; ≥4.5 cm at the time of AVRIsselbacher 2022- Aortic size index
ASI = diameter[cm] / BSA; <2.75 low, 2.75–4.24 moderate, ≥4.25 cm/m² high risk of rupture/dissectionDavies 2006- Cross-sectional area / height
π (d/2)² [cm²] / height[m] >10 identifies increased dissection riskSvensson 2003Isselbacher 2022- Sinus Z-score (Devereux 2012)
Predicted = 2.423 + 0.009 × age + 0.461 × BSA(DuBois) − 0.267 × sex, SEE 0.261 cm (sex 1 = M, 2 = F) · Height model: 1.519 + 0.010 × age + 0.010 × height[cm] − 0.247 × sex, SEE 0.215 cm · Z = (measured − predicted) / SEEDevereux 2012- Sinus Z-score (Roman 1989)
Age 20–40: predicted = 0.97 + 1.12 × BSA, SD 0.24 cm · age >40: 1.92 + 0.74 × BSA, SD 0.37 cmRoman 1989
Exercise stress test
Formulas & sources
- Duke treadmill score
DTS = exercise minutes (Bruce) − 5 × ST deviation [mm] − 4 × angina index (0 none, 1 non-limiting, 2 limiting); ≥+5 low, −10 to +4 intermediate, ≤−11 high riskMark 1991- METs by Bruce stage
Stage end values 4.6, 7.0, 10.1, 12.9, 15.0, 16.9, 19.1 METs (modified Bruce adds 2.3 and 3.5 for the two warm-up stages); interpolated linearly within a stageBruce 1973ACSM 2021- METs by regression (Foster)
VO₂ = 14.76 − 1.379 T + 0.451 T² − 0.012 T³ (T = Bruce minutes); METs = VO₂ / 3.5Foster 1984- METs by regression (Pollock, women)
VO₂ = 4.38 T − 3.9; METs = VO₂ / 3.5Pollock 1982- Age-predicted exercise capacity
Men: 18 − 0.15 × age (Morris) · Women: 14.7 − 0.13 × age (Gulati); <85% of predicted is prognostically adverseMorris 1993Gulati 2005- Age-predicted maximal HR
220 − age (85% target for an adequate test); Tanaka: 208 − 0.7 × ageTanaka 2001- Chronotropic index
(peak HR − rest HR) / (220 − age − rest HR); <0.80 = chronotropic incompetenceLauer 1999- Heart-rate recovery
Peak HR − HR at 1 min of recovery; ≤12 bpm abnormal (upright cool-down)Cole 1999- Rate–pressure product and BP response
RPP = peak HR × peak SBP; a fall in SBP below the resting value is a high-risk responseACSM 2021