Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study

Eur Heart J Cardiovasc Imaging. 2014 Jun;15(6):680-90. doi: 10.1093/ehjci/jet284. Epub 2014 Jan 21.


Aims: Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges for cardiac chambers size obtained in a large group of healthy volunteers accounting for gender and age. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following chamber quantitation protocols approved by the European Association of Cardiovascular Imaging.

Methods: A total of 734 (mean age: 45.8 ± 13.3 years) healthy volunteers (320 men and 414 women) were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was performed on all subjects following pre-defined protocols. There were no gender differences in age or cholesterol levels. Compared with men, women had significantly smaller body surface areas, and lower blood pressure. Quality of echocardiographic data sets was good to excellent in the majority of patients. Upper and lower reference limits were higher in men than in women. The reference values varied with age. These age-related changes persisted for most parameters after normalization for the body surface area.

Conclusion: The NORRE study provides useful two-dimensional echocardiographic reference ranges for cardiac chamber quantification. These data highlight the need for body size normalization that should be performed together with age-and gender-specific assessment for the most echocardiographic parameters.

Keywords: Chamber size and function; Reference values; Two-dimensional echocardiography.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cohort Studies
  • Echocardiography / methods*
  • Female
  • Heart Atria / anatomy & histology
  • Heart Atria / diagnostic imaging*
  • Heart Ventricles / anatomy & histology
  • Heart Ventricles / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Reference Values
  • Reproducibility of Results
  • Risk Assessment
  • Sex Factors
  • Stroke Volume / physiology
  • Young Adult