The module Echocardiography is used to document parameters of transthoracic echocardiography examinations.
These examinations ought to be performed according to DZHK-SOP-K-08 .
 

Examination details

Was the echocardiography performed?

  Fieldname: echo_janein
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Date of examination

  Fieldname: echo_date
  Data type: Timestamp with day, month and year

Quality level

  • Level 1: The examination is performed in accordance with the guidelines of the medical associations.
  • Level 2: The examination is performed in accordance with the specifications of the DZHK SOP. Minimum requirements to ensure the quality of the implementation and the examiners are defined in the SOP.
  • Level 3: The examination is performed in accordance with the specifications of the DZHK SOP and certification of the examiners: Definition of intr-observer and interobserver-variability (standard of epidemiological studies).
DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
  Fieldname: gehtest_qualitaet
  Data type: Integer with following options
    1
    2
    3

Examination

Heart rate

  Fieldname: echo_frequenz 
  Data type: Integer with 3 decimal places in min

Rhythm

Sinus rhythm

  Fieldname: echo_sinus
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Atrial fibrillation

  Fieldname: echo_vorhof
  Data type: String wit following options
    yes
    no
    unknown
    not assessed

Pacemaker

  Fieldname: echo_schritt
  Data type: String with following options
    yes
    no
    unknown
    not assessed
  Fieldname: echo_schritttyp
  Data type: String with following options
    PM+sinus rhythm 
    PM+atrial fibrillation 
    stimulation mode

other rhythm

  Fieldname: echo_rhythm_andere
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Image quality

Imaging modalities for all settings

  • 1. For patients with sinus rhythm, 3 cardiac cycles are recorded (this applies to still images and Cineloop/sequence) and stored digitally; for patients with atrial fibrillation, 5 cardiac cycles are recorded and saved
  • 2. ES measurement means end of the T-wave or largest thickness of the myocardium
  • 3. ED measurement means near the Q-peak or start of the QRS complex
  • 4. Throughput speed 50-100/min
  • 5. Throughout the examination, ensure a simultaneous ECG curve with correct rendering of the P-wave (if available) and QRS complex
  • 6. In patients with sinus rhythm, ideally 3 measurements of the predefined parameters are carried out, or 3 values are calculated; in patients with atrial fibrillation, ideally 5 measurements/calculations are carried out; in case of extrasystoles, ideally 3 measurements of normal heartbeats are also carried out not before or after an extrasystole.
  • DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    System of examination requirements

    For all standard sections recorded during echocardiography, the following chapters summarise recommendations for the data collection with regard to the modality (e.g. M-mode, 2D), the structures to be imaged, the quality criteria and the reading. The following abbreviat ions are used:
    • A: Recording
    • S: Structures to be visualised and assessed
    • Q: Quality criteria
    • R: Reading
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    Parasternal long axis

      Fieldname: echo_para_lang
      Datat type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Parasternal short axis

      Fieldname: echo_para_kurz
      Data type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Apical four-chamber view

    4-CH (with LA/ RA)

  • A: 2D mode(sequece)
  • S: 1. Atrial and ventricular septum
    2. Lateral wall of the LV
    3. LA+RA area
    4. Tricuspid valve (anterior and septal leaflet) and mitral valve (anterior and posterior leaflet)
    5. LVEF (visual estimation)
  • Q: 1. The septum should be perpendicular
    2. The septal mitral valve insertion should be at the same height as the tricuspid valve insertion
    3. The left ventricle should be visualised in such a way that an axis as long as possible (from the middle of the connecting line of the mitral leaflet insertion points to the apex) is displayed
    4. The depth should be minimised in order to visualise the LA as large as possible and in its entirety
  • R: Measurements (see Table 12 - Measurements in the apical four-chamber view)
  • DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    4-CH (without LA/ RA)

  • A: 2D mode(sequence)
  • S: 1. Ventricular septum
    2. Lateral wall of the LV
    3. Tricuspid valve (anterior and septal leaflet)
    4. Mitral valve (anterior and posterior leaflet)
    5. LVEF (biplane according to Simpson, see also 2-CH)
    6. RV area and function
    7. Assessment: pericardium/ pericardial border
  • Q: 1. The LV should be displayed along its long axis to avoid shortening. If necessary, take separate images to allow for an assessment of the LV and RV, as an optimal simultaneous visualisation is not always possible. (image optimised for the right side for right-ventricular measurements)
    2. The penetration depth should be minimised in order to visualise the LV as large as possible and with the complete apex (the LA should be cut off)
  • R: 1. Visual assessment of the LV function / kinetics of the septal and lateral wall (wall motion disorder: yes, no, unknown, not assessed)
    2. Measurements (see Table 13-Measured values for the left and right ventricular diameter, Table 14–Heart valve parameters on the 2D image and Table 15-Calculated parameters from the planimetry)
  • DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_apik_vier
      Data type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Apical three-chamber view

  • A: 2D (sequence)
  • S:Left atrium and left ventricle (septal and inferolateral segments), aortic valve (right coronary and non-coronary cusp) as well as A2- and P2-segments of the mitral valve, measurements of the aortic valve/mitral valve in the three-chamber view only complementary, performance as previously outlined
  • Q: 1. The left ventricle should be visualised in the optimal length and completely stretched
         2. The septum should be perpendicular to the lower part of the image
  • R: Visual assessment of the anteroseptal and inferolateral wall sections, the measurements of the aortic valve are performed analogously to the measurements in the apical five-chamber view.
  • DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_apik_drei
      Data type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Apical two-chamber view

  • A: 2D (sequence)
  • S: Complete visualisation of the anterior and inferior part of the LV and of the left atrium as well as of the mitral valve, segment P1, A2 and P3 (optionally coronary sinus/left atrial appendage), measurements of the mitral valve as outlined in the section on the four-chamber view
  • Q: 1. The left ventricle should be visualised in the optimal length and completely stretched
         2. The septum should be perpendicular to the lower part of the image
  • R: Visual assessment of the kinetics of the anterior and inferior wall sections, the measurements in the area of the mitral valve are performed analogously to the measurement in the four-chamber view. The LA volumetry (end-systolic) should be recorded biplane (from the insonation in the four-and two-chamber view)
  • DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_apik_zwei
      Data type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Subcostal

      Fieldname: echo_subkos
      Data type: String with following options
        proper axial alignment with good image quality
        axis deviation with good image quality
        unknown (limited possibility of assessment)
        not assessed
    

    Dimensions (long axis: M-mode parasternal)

    Parameters of 2D image rendition/M-mode

    Depending on the manufacturer's specifications, always use the lowest sound output power at which ultrasound images with sufficient quality can be obtained. Adjust the overall gain and depth regulation until the structures in the 2D image sector are optimally delimited. The same applies to the gain in the longitudinal direction or lateral direction; adjust the settings depending on the cross-sectional plane and the desired image quality. To achieve an optimal contrast on the images, also adjust the compression individually depending on the examination conditions. A frame rate of 50 frames/second is advisable.

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    M-mode measured in

      Fieldname: echo_mmode
      Data type: String with following options
        parasternal long axis
        parasternal short axis
        2D
        anatomical M-mode
        unknown (impossible to locate)
        not assessed
    

    Aortic root diameter (endsystolic) (AO)

      Fieldname: echo_aorta
      Data type: Integer with 2 decimal places in mm
    

    Left atrium (end-systolic) (LA diam)

      Fieldname: echo_ladiam
      Data type: Integer with 2 decimal places in mm
    

    Interventricular septum (end-diastolic) (IVSd)

      Fieldname: echo_ivsd
      Data type: Integer with 2 decimal places in mm
    

    Leftventricular end-diastolic diameter (LVEDd)

      Fieldname: echo_ivedd
      Data type: Integer with 2 decimal places in mm
    

    Left ventricular posterior wall (LVPWd)

      Fieldname: echo_lvpwd
      Data type: Integer with 2 decimal places in mm
    

    Left ventricular end-systolic diameter (LVEDs)

      Fieldname: echo_lveds
      Data type: Integer with 2 decimal places in mm
    

    2-D measurements (4CH and 2CH apical, subcostal)

    Left ventricular ejection fraction (LV-EF)

      Fieldname: echo_lvef
      Data type: Integer with 2 decimal places in %
    

    Method

      Fieldname: echo_methode
      Data type: String with following options
        Simpson biplane
        Simpson monoplane (4CH)
        visual
        unknown
        not assessed
    

    Left ventricular end-diastolic volume (LVEDV)

      Fieldname: echo_lvedv
      Data type: Integer with 3 decimal places in ml
    

    Left ventricular end-systolic volume (LVESV)

      Fieldname: echo_lvesv
      Data type: Integer with 3 decimal places in ml
    

    Left atrium AP longitudinal (end-systolic) (LAs (ap.längs))

      Fieldname: echo_laes_lang
      Data type: Integer with 2 decimal places in mm
    

    Left atrium AP transversal (end-systolic) (LAs (ap.quer))

      Fieldname: echo_laes_quer
      Data type: Integer with 2 decimal places in mm
    

    Left atrial area 4-chamber view (end-systolic) (LA-area(4CH))

      Feldname: echo_la_area_4ch
      Data type: Floating point number with 2 decimal places and 1 decimal place after comma in cm
    

    Left atrial area 2-chamber view (end-systolic) (A2 LA area (2CH)s)

      Fieldname: echo_la_area_2ch
      Data type: Floating point number with 2 decimal places and 1 places after comma in cm
    

    Wall motion disorder

      Fieldname: echo_wandbeweg
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    RV dilatation (mid-ventricular)

    RV dilation is defined by means of the mid-ventricular end-diastolic diameter (RVED2). RV dilation is defined as RVED2 > 34 mm

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_rv
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    TAPSE (tricuspid annular plane systolic excursion)

  • A: M-mode
  • S: Distance between the end-diastolic and end-systolic movement of the lateral insertionof the tricuspid valve
  • Q: The M-mode beam should be positioned in the lateral tricuspid valve annulus. The direction of movement of the lateral tricuspid annulus has to be parallel to the M-mode scan line; the angle of insonation may have to be adjusted for this
  • R: Measurements
  • Measured parameter (unit)    Measuring time    Position of the measuring points
    TAPSE (mm) ES to ED Endocardial border line (ES)
    Endocardial border line (ED)
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_tapse
      Data type: Integer with 2 decimal places in mm
    

    MAPSE (mitral annular plane systolic excursion) lateral

      Fieldname: echo_mapse_lat
      Data type: Integer with 2 decimal places in mm
    

    MAPSE septal

      Fieldname: echo_mapse_sep
      Data type: Integer with 2 decimal places in mm
    

    Pericardial effusion

    EPericardial effusion is present when echo free pericardial separation is demonstrated at the end of the diastole (>1 mm )

    A pericardial effusion should always be evaluated in different cross-sectional planes, usually in the parasternal long axis, in the apical 4-chamber view and in the subcostal cross-section. The width of the effusion can be measured at the end of the diastole using the M-mode recording in the parasternal long axis, if possible orthogonally to the separation caused by the effusion or alternatively by means of apical cross-sectional images. Effusions that are visible at the end of the diastole can be classified as small (20 mm).

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_perikarderguss
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Vena cava diameter

      Fieldname: echo_vencava_dm
      Data type: Integer with 2 decimal places in mm
    

    Vena cava response to breathing (>50% decrease on inspiration)

      Fieldname: echo_venacava_atem
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Parameters of Doppler procedures

    The gain of the colour Doppler should only be slightly in front of the background; adjust the gain of the spectral Doppler curves until the respective envelope curves are optimally visualised. Adjust the zero line and velocity range until the flow profiles to be measured are complete; the velocity range should be slightly above the maximum velocity. The sample volume of the PW Doppler should be 3 mm, the sample volume of the tissue Doppler 5 mm. Recommendations for adjusting the wall filter and for adjusting the pulse repetition rate of the colour Doppler may be found in the individual settings.

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    Recording speed

    For the 2D image/M-mode and colour Doppler, a recording speed of 50 mm/s should be selected; for spectral and tissue Doppler, a speed of 100 mm/s should be selected. For M-mode colour recordings (propagation velocity) 100-200 mm/s should be selected.
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    Mitral valve Doppler (PW)

    E-wave

      Fieldname: echo_e_welle
      Data type: Integer with 3 decimal places in m/s
    

    A-wave

      Fieldname: echo_a_welle
      Data type: Integer with 3 decimal places in m/s
    

    Tissue Doppler (TDI)

    E and A wave (lateral)

    Measured paramters     Measuring times     Position of the measuring points
    E'lat (cm/s)Early diastoleVmaxof the E'-wave
    A'lat (cm/s)Late diastoleVmax of the A'-wave
    S'lat (cm/s)SystolicVmax of the S'-wave
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    E'-wave (lateral)

      Fieldname: echo_e_welle_lateral
      Data type: Floating point number with 2 decimal places and 1 place after comma in cm/s
    

    A'-wave (lateral)

      Fieldname: echo_a_welle_lateral
      Data type: floating point number with 2 decimal places and 1 place after comma in cm/s
    

    S' (lateral)

      Fieldname: echo_s_lateral
      Data type: floating point number with 2 decimal places and 1 place after comma in cm/s
    

    TDI lat cannot be measured

      Fieldname: echo_lateral_nicht
      Data type: Checkbox
    

    E and A (medial)

    Measured paramter     Measuring time     Position of the measuring
    E'med (cm/s)Early diastoleVmax of the E'-wave
    A'med (cm/s)Late diastoleVmax of the A'-wave
    S'med (cm/s)SystolicVmax of the S'-wave
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    E'-Wave (medial)

      Fieldname: echo_e_welle_medial
      Data type: floating point number with 2 decimal places and 1 place after comma in cm/s
    

    A'-Welle (medial)

    Fieldname: echo_a_welle_medial
    Data type:floating point number with 2 decimal places and 1 place after comma in cm/s
    

    S' (medial)

    Fieldname: echo_s_medial
    Data type: floating point number with 2 decimal places and 1 place after comma in cm/s
    

    TDI sep cannot be measured

    Fieldname: echo_septal_nicht
    Data type: Checkbox
    

    Pulmonary venous flow

    Systolic flow

    Pulmonary venous systolic velocity (PVsVel)

      Fieldname: echo_sys_fluss
      Data type: Integer with 2 decimal places in cm/s
    

    Diastolic flow

    Pulmonary venous diastolic velocity (PVdVel)

      Fieldname: echo_dia_fluss
      Data type: Integer with 2 decimal places in cm/s
    

    Valves

    Quantification of valve defects

    The listed criteria that are used to quantify defects are always based on different parameters. The assessment of whether and to what extent a defect is present is incumbent upon the examiner, who has to take into account the various parameters. The criteria should be applied to "native heart valves", not after replacement (biological or mechanical).

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

    Mitral valve

      Fieldname: echo_mitral
      Data type: String with following options
        native
        post-surgical
        unknown
        not assessed
    

    Status post mitral valve surgery

      Fieldname: echo_mitral_op
      Data type: String with following options
        mitral valve reconstruction
        biological mitral valve replacement
        mechanical mitral valve replacement
        interventional reconstruction/clipping
        unknown
        not assessed
    

    Mitral valve morphology

      Fieldname: echo_mitral_morpho
      Data type: String with following options
        normal
        abnormal
        unknown
        not assessed
    

    Sclerosis

      Fieldname: echo_msklerose
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Mitral leaflet calcification

      Fieldname: echo_msegel
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Mitral annular calcification

      Fieldname: echo_mring
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Separation disorder

      Fieldname: echo_mseparat
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Flail leaflet

      Fieldname: echo_mleaflet
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Myxomatous prolapse

      Fieldname: echo_mprolaps
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Prolapse due to fibroelastic deficiency

      Fieldname: echo_mprolaps_defiz
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Pseudo-prolapse

      Fieldname: echo_mpseudo
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Mitral valve insufficiency (MI)

        Severity    
    Criteria 1 (mild) 2 (moderate) 3 (severe)
    Qualitative
    Mitral valve morphology Normal/ abnormal Normal/ abnormal Flail leaflet/ ruptured papillary muscles
    Colour Doppler of the insufficiency jet small, central intermediate Very large central jet or eccentric jet adhering swirling and reaching the posterior wall of the LA
    Flow convergence zone (Nyquist 50-60 cm/s) None or small intermediate large
    CW Signal of the insufficiency jets Faint/parabolic Dense/parabolic Dence/ triangular
    Semi-quantitative
    Vena contracta width (mm) >3 intermediate ≥7 (>8 for the mean of a biplane measurement)
    Pulmonary vein flow Systolic dominance Systolic blunting Systolic flow reversal
    Mitral inflow A-wave dominant variable E-wave dominant (>1,5 cm/s)
    TVI with/ TVI Ao >1 intermediate >1,4
    Quantitative
    EROA (mm2) <20 20-29; 30-39 ≥40
    R Vol (mL) <30 30-44; 45-59 ≥60
    + LV and LA size and the systolic pulmonary arterial pressure
    Abbreviations:: CW, contious wave; LA, left atrium, EROA, effective regurgitant orifice area; LV linker ventrikel; MR, mitral regurgitation; R Vol, regurgitant volume; VC, Vena contracta

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_mitral_insuf
      Data type: String with following options
        no MI
        mild MI
        moderate MI
        severe MI
        unknown (cannot be determined)
        not assessed
    

    Mitral valve stenosis (MS)

        Severity    
    Criteria 1 (mild) 2 (moderate) 3 (severe)
    Specific findings
    Valve opening area (cm2) >1,5 1,0-1,5 <1,0
    Supportive findings
    Mean gradient (mmHg) <5 5-10 >10
    Pulmonary artery pressure (mmHg) <30 30-50 >50
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_mitral_sten
      Data type: String with following options
        no MS
        mild MS
        moderate MS
        severe MS
        unknown (cannot be determined)
        not assessed
    

    Aortic valve

    Assessed parameter (unit)    Visual assessment of the valve    
    Aortic valve Native, post-surgical (status post biological view)
    replacement (yes/no), status post mechanical view
    replacement (yes/no), status post interventional valve
    replacement (yes/no), unknown, not assessed

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_aorte
      Data type: String with following options
        native
        post-surgical
        unknown
        not assessed
    

    Status post aortic valve

      Fieldname: echo_aorten_op
      Data type: String with following options
        status post biological aortic valve replacement surgery
        status post mechanical aortic valve replacement surgery
        status post interventional aortic valve replacement surgery
        unknown
        not assessed
    

    Aortic valve morphology

      Fieldname: echo_aorten_morpho
      Data type: String with following options
        normal
        abnormal
        unknown
        not assessed
    

    Sclerosis

      Fieldname: echo_asklerose
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Calcification

      Fieldname: echo_akalk
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Separation disorder

      Fieldname: echo_aseparat
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    bicuspid

      Fieldname: echo_abikuspid
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Aortic valve insufficiency (AI)

        Severity    
    Parameters 1 (mild) 2 (moderate) 3 (severe)
    Qualitative
    Aortic valve morphology Normal/ abnormal Normal/ abnormal Abnormal/ flail/ large coaptation defect
    Colour flow AR jet width (at Nyquist 50-60 cm/s) small, central intermediate large in central jet, variable in eccentric jets
    CW signal of AR jets Incomplete/ faint Dense Dense
    Diastolic flow reversal in the descending aorta Brief, protodiastolic flow reversal Intermediate Holodiastolic flow reversal (end-diastolic velocity >20 cm/s)
    Semiquantitative
    Vena contracta width (mm) >3 intermediate >6
    Pressure half-time (ms) >500 intermediate <200
    Quantitativ
    EROA (mm2) <10 10-19; 20-29 ≥30
    R Vol (mL) <30 30-44; 45-59 ≥60
    + LV size
    Abbreviations: AR Aortic regurgitation, CW, continuous wave; LA, linker atrium; EROA, effective regurgitant orifice area; IVC, inferiore Vena cava; LV, linker ventricle; R Vol, regurgitant volume; VC, Vena contracta

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_aorten_insuf
      Data type: String with following options
        no AI
        mild AI
        mild AI
        severe AI
        unknown (cannot be determined)
        not assessed
    

    Aortic valve stenosis (AS)

        Severity    
    Criteria Aortic sklerosis 1 (mild) 2 (moderate) 3 (severe)
    Aortic valve jet velocity (Vmax)(m/s) ≤2,5m/s 2,6-2,9 3,0-4,0 >4,0
    Mean gradient (mmHg) - <20 (<30) 20-40 (30-50) >40 (>50)
    AVA-Valve opening area (cm2) >1,5 1,0-1,5 <1,0
    Indexed Valve opening area per body surface area (cm2/m2) >0,85 0,60-0,85 <0,6
    Velocity ratio >0,5 0,25-0,50 <0,25
    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014
      Fieldname: echo_aorten_sten
      Data type: String with following options
        no AS
        mild AS
        moderate AS
        severe AS
        unknown (cannot be determined)
        not assessed
    

    Pulmonary valve

      Fieldname: echo_pulm
      Data type: String with following options
        native
        post-surgical
        unknown
        not assessed
    

    Pulmonary valve morphology

      Fieldname: echo_pulm_morpho
      Data type: String with following options
        normal
        abnormal
        unknown
        not assessed
    

    Sclerosis

      Fieldname: echo_psklerose
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Calcification

      Fieldname: echo_pkalk
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Separation disorder

      Fieldname: echo_pseparat
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Pulmonary valve insufficiency (PI)

        Severity    
    Criteria 1 (mild) 2 (moderate) 3 (severe)
    Qualitative
    Pulmonary valve morphology Normal Normal/ abnormal abnormal
    Colour flow PR jet width (at Nyquist 50-60 cm/s) Small, usually <10 mm in length with a narrow origin intermediate Large, with a wide origin; may be brief in duration
    CW signal of PR jet Faint/ slow deceleration Dense/variable Dense/ steep deceleration eraly termination of diastolic flow
    Pulmonic vs. aortic flow by PW Doppler Normal or slightly increased intermediate Greatly increased
    Semiquantitative
    Vena contracta width (mm) Not defined Not defined Not defined
    Quantitativ
    EROA (mm2) Not defined Not defined Not defined
    R Vol (mL) Not defined Not defined Not defined
    + RV size
    Abbreviations: AR Aorten regurgitation, CW, contious wave; LA, linker Vorhof; EROA, effective regurgitant orifice area; IVC, inferiore Vena cava; LV, linker Ventrikel; R Vol, Regurgitant volume; VC, Vena contracta

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_pulm_insuf
      Data type: String with following options
        no PI
        mild PI
        moderate PI
        severe PI
        unknown (cannot be determined)
        not assessed
    

    Tricuspid valve

      Fieldname: echo_trikus
      Data type: String with following options
        native
        post-surgical
        unknown
        not assessed
    

    Trikuspid valve morphology

      Fieldname: echo_trikus_morpho
      Data type: String with following options
        normal
        abnormal
        unknown
        not assessed
    

    Sclerosis

      Fieldname: echo_tsklerose
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Calcification

      Fieldname: echo_tkalk
      Data type: String with following options
        Yes
        no
        unknown
        not assessed
    

    Ebstein

      Fieldname: echo_tebstein
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Anomaly

      Fieldname: echo_tanomalie
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Separation disorder

      Fieldname: echo_tseparat
      Data type: String with following options
        yes
        no
        unknown
        not assessed
    

    Tricuspid valve insufficiency (TI)

        Severity    
    Criteria 1 (mild) 2 (moderate) 3 (severe)
    Qualitative
    Trikuspid valve morphology Normal/ abnormal Normal/ abnormal Abnormal/ flail/ large coaptation defect
    Colour flow TR jet (at Nyquist 50-60 cm/s) small,central intermediate Very large central jet or eccentric wall-impinging jet
    CW signal of TR Jets Faint/ parabolic Dense/ parabolic Dense/ triangular with early peak (peak <2m/s in massive TR)
    Semiquantitative
    Vena contracta width (mm) Not defined <7 ≥7
    PISA radius (mm) ≥5 6-9 >9
    Hepatic vein flow Systolic dominance Systolic blunting Systolic flow reversal
    Trikuspid inflow normal normal E-wave dominant (≥1cm/s)
    Quantitative
    EROA (mm2) Not defined Not defined ≥40
    R Vol (mL) Not defined Not defined ≥45
    + RA/RV/IVC Größe
    Abbreviations: CW, contious wave; LA, left atrium, EROA, effective regurgitant orifice area; LV linker ventrikel; MR, mitral regurgitation; R Vol, regurgitant volume; VC, Vena contracta

    DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014

      Fieldname: echo_trikus_insuf
      Data type: String with following options
        no TI
        mild TI
        moderate TI
        severe TI
        unknown
        not assessed