Right Heart Structure & Function: Reference Limits

Adapted from: Mukherjee, Monica et al. "Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography." Journal of the American Society of Echocardiography, Volume 38, Issue 3, 141-186 (2025).
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Adapted from the 2025 ASE Guideline
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Chamber Dimensions +
RA major dimension, cm
Normal: <5.4
Mild: ≥5.4 to ≤5.8
Moderate: >5.8 to ≤6.3
Severe: >6.3
RA minor dimension, cm
Normal: <4.2
Mild: ≥4.2 to ≤4.7
Moderate: >4.7 to ≤5.1
Severe: >5.1
RA area, cm²
Normal: <19
Mild: ≥19 to ≤22
Moderate: >22 to ≤24
Severe: >24
RAV index (method of disks), mL/m²
Normal: <30
Mild: ≥30 to ≤36
Moderate: >36 to ≤41
Severe: >41
RAV index (area-length method), mL/m²
Normal: <33
Mild: ≥33 to ≤38
Moderate: >39 to ≤44
Severe: >44
RA end-systolic volume index (3D method), mL/m²
Normal: <42
Mild: ≥42 to ≤49
Moderate: >49 to ≤57
Severe: >57
RA end-diastolic volume index (3D method), mL/m²
Normal: <20
Mild: ≥20 to ≤23
Moderate: >23 to ≤27
Severe: >27
RV diameter basal, cm
Normal: <4.1
Mild: ≥4.1 to ≤4.4
Moderate: >4.4 to ≤4.9
Severe: >4.9
RV diameter basal index, cm/m²
Normal: <2.4
Mild: ≥2.4 to ≤2.6
Moderate: >2.6 to ≤2.9
Severe: >2.9
RV diameter midventricular, cm
Normal: <3.5
Mild: ≥3.5 to ≤3.8
Moderate: >3.8 to ≤4.2
Severe: >4.2
RV diameter longitudinal, cm
Normal: <8.2
Mild: ≥8.2 to ≤8.9
Moderate: >8.9 to ≤9.6
Severe: >9.6
RVOT PLAX diameter, cm
Normal: <3.3
Mild: ≥3.3 to ≤3.5
Moderate: >3.5 to ≤3.9
Severe: >3.9
RVOT PSAX proximal diameter, cm
Normal: <3.4
Mild: ≥3.4 to ≤3.8
Moderate: >3.8 to ≤4.1
Severe: >4.1
RVOT PSAX distal diameter, cm
Normal: <2.9
Mild: ≥2.9 to ≤3.0
Moderate: >3.0 to ≤3.3
Severe: >3.3
RVWT, cm
Normal: <0.5
Mild: ≥0.5 to ≤0.7
Moderate: >0.7 to ≤0.9
Severe: >0.9
RV end-systolic area, cm²
Normal: <14
Mild: ≥14 to ≤16
Moderate: >16 to ≤19
Severe: >19
RV end-systolic area index, cm²/m²
Normal: <8
Mild: ≥8 to ≤9
Moderate: >9 to ≤11
Severe: >11
RV end-diastolic area, cm²
Normal: <25
Mild: ≥25 to ≤28
Moderate: >28 to ≤32
Severe: >32
RV end-diastolic area index, cm²/m²
Normal: <14
Mild: ≥14 to ≤15
Moderate: >15 to ≤17
Severe: >17
3D end-systolic volume, mL
Normal: <66
Mild: ≥66 to ≤77
Moderate: >77 to ≤89
Severe: >89
3D end-systolic volume index, mL/m²
Normal: <41
Mild: ≥41 to ≤48
Moderate: >48 to ≤55
Severe: >55
3D end-diastolic volume, mL
Normal: <130
Mild: ≥130 to ≤150
Moderate: >150 to ≤170
Severe: >170
3D end-diastolic volume index, mL/m²
Normal: <90
Mild: ≥90 to ≤103
Moderate: >103 to ≤115
Severe: >115
PA, cm
Normal: <2.5
Mild: ≥2.5 to ≤3.0
Moderate: >3.0 to ≤3.5
Severe: >3.5
RV Systolic Function +
TAPSE, cm
Normal: >1.7
Mild: ≤1.7 to ≥1.3
Moderate: ≤1.3 to >1.0
Severe: ≤1.0
Tissue Doppler S′ velocity, cm/s
Normal: >9.5
Mild: ≤9.5 to ≥7.2
Moderate: ≤7.2 to >5.0
Severe: ≤5.0
Tissue Doppler RV MPI
Normal: <0.55
Mild: ≥0.55 to <0.62
Moderate: ≥0.62 to <0.70
Severe: ≥0.70
Pulsed Doppler RV MPI
Normal: <0.40
Mild: ≥0.40 to <0.49
Moderate: ≥0.49 to <0.57
Severe: ≥0.57
FAC, %
Normal: >35
Mild: ≤35 to >29
Moderate: ≤29 to >22
Severe: ≤22
3D RVEF, %
Normal: >45
Mild: ≤45 to <39
Moderate: ≤39 to ≥32
Severe: <32
RV longitudinal free wall strain (three segment), %
Normal: >20
Mild: ≤20 to <15
Moderate: <15 to ≥11
Severe: <11
RV longitudinal global strain (six segment), %
Normal: >17
Mild: ≤17 to >13
Moderate: ≤13 to >9
Severe: ≤9
(NOTE: strain uses |absolute values|)
RV Diastolic Function +
RV E/A ratio
Normal: ≥0.8 to <2.0
Mild: <0.8 (Impaired relaxation)
Moderate: 0.8 to 2.1 (Pseudonormal)
Severe: >2.1 (Restrictive)
RV e′/a′ ratio
Normal: ≥0.5 to <1.8
Mild: ≥1.8 to ≤2.1
Moderate: >2.1 to ≤2.4
Severe: ≥2.5
RV E/e′ ratio
Normal: <6.0
Mild: ≥6.0 to ≤7.3
Moderate: >7.3 to ≤8.4
Severe: ≥8.5
Deceleration time, ms
Normal: ≥120 to ≤230
Mild: ≥87 to <120
Moderate: ≥57 to <87
Severe: ≤57
Hemodynamics +
TRV maximum, m/s
Normal: <2.8
Mild: ≥2.8 to ≤3.1
Moderate: ≥3.2 to ≤3.5
Severe: ≥3.6
RVSP, mm Hg
Normal: ≤34
Mild: ≥35 to ≤49
Moderate: ≥50 to ≤69
Severe: ≥70
RAP, mm Hg
Normal: ≥0 to <5 (mean 3)
Mild: ≥5 to <10 (mean 8)
Moderate: ≥10 to <15
Severe: ≥15
RVOT AccT, ms
Normal: >105
Mild: ≥80 to ≤105
Moderate: ≥60 to <80
Severe: ≤60
WASE Height-Indexed Values +
Source: Addetia K, et al. and the WASE Investigators. Two-Dimensional Echocardiographic Right Ventricular Size and Systolic Function Measurements Stratified by Sex, Age, and Ethnicity: Results of the World Alliance of Societies of Echocardiography Study. J Am Soc Echocardiogr. 2021 Nov;34(11):1148-1157.e1.

Read about why height-indexed values are important: Impact of Body Habitus on Reference Limits

RV base/height, cm/m
Normal: <2.5 (All); <2.5 (Female); <2.6 (Male)
Mild: ≥2.5 to <2.8
Moderate: ≥2.8 to <3.1
Severe: ≥3.1
RV mid/height, cm/m
Normal: <2.2 (All); <2.1 (Female); <2.3 (Male)
Mild: ≥2.2 to <2.5
Moderate: ≥2.5 to <2.8
Severe: ≥2.8
RV length/height, cm/m
Normal: <5.3 (All); <5.3 (Female); <5.4 (Male)
Mild: ≥5.3 to <5.8
Moderate: ≥5.8 to <6.3
Severe: ≥6.3
RVOT (PSAX)/height, cm/m
Normal: <2.1 (All); <2.1 (Female); <2.1 (Male)
Mild: ≥2.1 to <2.4
Moderate: ≥2.4 to <2.6
Severe: ≥2.6
RVOT (proximal, SAX)/height, cm/m
Normal: <2.3 (All); <2.3 (Female); <2.2 (Male)
Mild: ≥2.3 to <2.6
Moderate: ≥2.6 to <2.9
Severe: ≥2.9
Tricuspid annulus/height, cm/m
Normal: <2.2 (All); <2.2 (Female); <2.3 (Male)
Mild: ≥2.2 to <2.5
Moderate: ≥2.5 to <2.8
Severe: ≥2.8

Note: These reference values are derived from the WASE study and are indexed to height, which may be preferable to BSA-indexing in certain populations (e.g., obesity). The normal upper limit is calculated as mean + 1.96 SD (95% confidence interval). Both combined and sex-specific normal limits are provided. The mild/moderate cutoff is at +3 SD and the moderate/severe cutoff is at + 4 SD (using the combined values).