Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data.
The Indian Normative TEE Measurements study was a multicenter, prospective observational study conducted in India.
Operating rooms for noncardiac surgeries in tertiary care–level hospitals.
Adult patients undergoing noncardiac surgery who were free from any cardiac, respiratory, and renal diseases and had no contraindications for TEE.
After inducing general anesthesia and achieving stable hemodynamic conditions, a comprehensive TEE examination was performed and various measurements were made.
Measurements and Main Results
For each of the 83 patients undergoing noncardiac surgery, 39 various measurements for left ventricle, right ventricle, both atria, and all valves were made. This included diameters and functional parameters. They were analyzed in a vendor-neutral software off-line. The absolute values of many of the measurements were higher in men, but when indexed to body surface area (BSA) they were similar in both sexes. The values were lower than most of the Western data but matched previous Indian studies using TTE.
The authors present normative values of various echocardiographic parameters using TEE. Because of its variations, it is recommended to use India-specific data to make decisions in Indian patients. It may be prudent to use BSA-indexed values during decision-making.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Echocardiographic Normal Ranges Meta-Analysis of the Left Heart (Echo-NoRMAL) Collaboration. A meta-analysis of echocardiographic measurements of the left heart for the development of normative reference ranges in a large international cohort: The EchoNoRMAL study.Eur Heart J Cardiovasc Imaging. 2014; 15: 341-348
- Echocardiographic reference ranges for normal cardiac chamber size: Results from the NORRE study.Eur Heart J Cardiovasc Imaging. 2014; 15: 680-690
- Echocardiographic measurements in normal Chinese adults focusing on cardiac chambers and great arteries: A prospective, nationwide, and multicenter study.J Am Soc Echocardiogr. 2015; 28: 570-579
- Normal values of echocardiographic parameters in relation to age in a healthy Japanese population: The JAMP study.Circ J. 2008; 72: 1859-1866
- Normal echocardiographic measurements in a Korean population study: Part I. Cardiac chamber and great artery evaluation.J Cardiovasc Ultrasound. 2015; 23: 158-172
- Similarities and differences in left ventricular size and function among races and nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study.J Am Soc Echocardiogr. 2019; 32: 1396-1406
- Normal echocardiographic measurements in Indian adults: How different are we from the Western populations? A pilot study.Indian Heart J. 2016; 68: 772-775
- Global longitudinal strain, ejection fraction, effort tolerance and normal echocardiography measurements in healthy Indians.Indian Heart J. 2018; 70: 637-641
- Real-time three-dimensional echocardiographic left heart parameters in healthy Indian patients.Indian Heart J. 2018; 70: 642-648
- A study on normal reference values of echocardiographic chamber dimensions in young eastern Indian adults.Indian Heart J. 2021; 73: 77-84
- Normative values of cardiac chamber dimensions and global longitudinal strain in Indians: The Indian Normative Data of Echocardiography Analyzed (INDEA) study.Int J Cardiovasc Imaging. 2021; 37: 871-880
- Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.J Am Soc Echocardiogr. 2013; 26: 921-964
- Reference values for left ventricular function in subjects under general anaesthesia and controlled ventilation assessed by two-dimensional transoesophageal echocardiography.Eur J Anaesthesiol. 2001; 18: 713-722
- Reference values for normal adult transesophageal measurements.J Am Soc Echocard. 1995; 8: 221-230
- Practice guidelines for perioperative transesophageal echocardiography: Recommendations of the Indian Association of Cardiovascular Thoracic Anesthesiologists.Ann Card Anaesth. 2013; 16: 268-278
- Mitral valve repair.in: Perrino AC Perrino ST A Practical Approach to Transesophageal Echocardiography. 3rd ed. Lippincott William & Wilkins, Philadelphia, PA, 19103 USA2008: 194-223
- Multinational institutional survey on patterns of intraoperative transesophageal echocardiography use in adult cardiac surgery.J Cardiothorac Vasc Anesth. 2014; 28: 5463
- Variations of transesophageal echocardiography practices in India: A survey by Indian College of Cardiac Anaesthesia.Ann Card Anaesth. 2016; 19: 646-652
- Cross-sectional multiplane transesophageal echocardiographic measurements: Comparison with standard transthoracic values obtained in the same setting.Echocardiography. 2002; 19: 383-390
- Assessing left ventricular dimensions in patients during coronary artery bypass surgery by transesophageal echocardiography.Turk J Anaesthesiol Reanim. 2017; 45: 367-373
- A comparative evaluation of transesophageal and transthoracic echocardiography for measurement of left ventricular systolic strain using speckle tracking.J Cardiothorac Vasc Anesth. 2012; 26: 17-25
- 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2017; 70: 252-289
- A critical appraisal of absolute left ventricular dimension thresholds for intervention in primary mitral regurgitation from a worldwide population perspective.J Am Soc Echocardiogr. 2021; 34: 205-206
- Prosthetic heart valves selection of the optimal prosthesis and long-term management.Circulation. 2009; 119: 1034-1048
- Patient prosthesis mismatch after aortic valve replacement: An Indian perspective.Ann Card Anaesth. 2016; 19: 84-88
- Mitral valve size measurements in north Karnataka by using cardiac sizer: A cadaveric study.Arch Med Health Sci. 2013; 1: 105-108
- Aortic valve annular dimension in Indian population.J Clin Diagnostic Res. 2013; 7: 1842-1845
- The study of mitral valve annular dimension in relation to the body surface area in the Indian population.Eur J Cardiothorac Surg. 2011; 39: 653-656
- Tricuspid valve: An intraoperative echocardiographic perspective.J Cardiothorac Vasc Anesth. 2014; 8: 761-770
- Recommendations for cardiac chamber quantification by echocardiography in adults: An update from American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39
- Population differences in brain morphology: Need for population specific brain template.Psychiatry Res Neuroimaging. 2017; 30: 1-8
- Construction of Indian human brain atlas.Neurol India. 2019; 67: 229-234
Published online: July 10, 2021
© 2021 Elsevier Inc. All rights reserved.