3D echocardiographic reference ranges for normal left ventricular volumes and strain: results from the EACVI NORRE study


  • Bernard Anne
  • Addetia Karima
  • Dulgheru Raluca
  • Caballero Luis
  • Sugimoto Tadafumi
  • Akhaladze Natela
  • Athanassopoulos George D.
  • Barone Daniele
  • Baroni Monica
  • Cardim Nuno
  • Hagendorff Andreas
  • Hristova Krasimira
  • Ilardi Federica
  • Lopez Teresa
  • Morena Gonzalo
  • Popescu Bogdan A.
  • Penicka Martin
  • Ozyigit Tolga
  • David Rodrigo Carbonero Jose
  • Veire Nico
  • Stephan von Bardeleben Ralph
  • Vinereanu Dragos
  • Luis Zamorano Jose
  • Martinez Christophe
  • Magne Julien
  • Cosyns Bernard
  • Donal Erwan
  • Habib Gilbert
  • Badano Luigi P.
  • Lang Roberto M.
  • Lancellotti Patrizio


  • Three-dimensional echocardiography
  • Left ventricular function
  • Reference values
  • Adult echocardiography
  • Deformation imaging


Aim: To obtain the normal ranges for 3D echocardiography (3DE) measurement of left ventricular (LV) volumes, function, and strain from a large group of healthy volunteers. Methods and results: A total of 440 (mean age: 45 ± 13 years) out of the 734 healthy subjects enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study had good-quality 3DE data sets that have been analysed with a vendor-independent software package allowing homogeneous measurements regardless of the echocardiographic machine used to acquire the data sets. Upper limits of LV end-diastolic and end-systolic volumes were larger in men (97 and 42 mL/m2) than in women (82 and 35 mL/m2; P < 0.0001). Conversely, lower limits of LV ejection fraction were higher in women than in men (51% vs. 50%; P < 0.01). Similarly, all strain components were higher in women than in men. Lower range was -18.6% in men and -19.5% in women for 3D longitudinal strain, -27.0% and -27.6% for 3D circumferential strain, -33.2% and -34.4% for 3D tangential strain and 38.8% and 40.7% for 3D radial strain, respectively. LV volumes decreased with age in both genders (P < 0.0001), whereas LV ejection fraction increased with age only in men. Among 3DE LV strain components, the only one, which did not change with age was longitudinal strain. Conclusion: The NORRE study provides applicable 3D echocardiographic reference ranges for LV function assessment. Our data highlight the importance of age- and gender-specific reference values for both LV volumes and strain.

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