SONIC

Normal values — Adult echocardiography

LV dimensions

LV EDD	42–58 mm (M) / 38–52 mm (F)
LV ESD	25–40 mm
IVS (diastole)	6–10 mm
PW (diastole)	6–10 mm
Indexed EDV	<97 mL/m² M / <76 F
Indexed LV mass	<115 g/m² M / <95 F

LV systolic function

Normal LVEF	>52% M / >54% F
Mildly reduced	41–51%
Mod. reduced	30–40%
Severely reduced	<30%
MAPSE	>8 mm
Lateral S' TDI	>7 cm/s

LVH — IVS or PW > 12 mm

HCM: IVS >15 mm asymmetric, mitral SAM, intra-LV gradient >30 mmHg. Concentric if HTN/AS.

Mitral Doppler

E wave	50–100 cm/s
A wave	30–80 cm/s
E/A	0.8–1.5
Deceleration time	150–220 ms
Septal e'	>7 cm/s
Lateral e'	>10 cm/s
Mean E/e' <8	Normal FP
Mean E/e' 9–14	Grey zone
Mean E/e' ≥15	Elevated FP
Indexed LA vol.	<34 mL/m²

Grade	Criteria	Filling P.
I	E/A <0.8 + DT >200 + e' <7	Normal
II	E/A 0.8–1.5 + E/e' 9–15	Elevated
III	E/A >1.5 + DT <150 + E/e' >15	Very high

3/4 criteria rule (ASE 2016)

Elevated FP if ≥2: septal e' <7 · mean E/e' >14 · peak TR vel >2.8 m/s · LA vol >34 mL/m²

RV dimensions & function

Basal diameter	<41 mm
TAPSE	≥17 mm
Tricuspid S' TDI	≥10 cm/s
FAC	>35%
RV/LV ratio	<0.6
RV free wall	<5 mm

Pulmonary pressures

Peak TR vel <2.8	PAH unlikely
Peak TR 2.8–3.4	PAH probable
Peak TR >3.4	PAH very likely
SPAP = 4×(Vmax)²+RAP
IVC <21mm + collapse >50%	RAP ≈3 mmHg

Acute Cor Pulmonale (PE)

RV/LV >0.6 · TAPSE <17 · McConnell sign · Paradoxical septum · Peak TR >2.8 · Dilated IVC · RV/RA thrombus

Parameter	Mild	Moderate	Severe
Vmax (m/s)	2–3	3–4	>4
Mean grad.	<25	25–40	>40
AVA (cm²)	>1.5	1.0–1.5	<1.0
Indexed AVA	—	—	<0.6 cm²/m²
VTI ratio	>0.5	0.25–0.5	<0.25

Parameter	Mild	Moderate	Severe
AR jet/LVOT	<25%	25–65%	>65%
Vena contracta	<3 mm	3–6 mm	>6 mm
Regurg. vol.	<30 mL	30–59 mL	>60 mL
PHT	>500 ms	200–500	<200 ms

Parameter	Mild	Moderate	Severe
MVA (cm²)	>1.5	1.0–1.5	<1.0
Mean grad.	<5	5–10	>10 mmHg
PHT	<100 ms	100–220	>220 ms
SPAP	<30	30–50	>50

Parameter	Mild	Moderate	Severe
Vena contracta	<3 mm	3–7 mm	>7 mm
ERO/PISA	<0.20	0.20–0.39	≥0.40 cm²
Regurg. vol.	<30 mL	30–59 mL	≥60 mL
Regurg. fraction	<30%	30–49%	≥50%

Aortic prosthesis — normal gradients

Size	Mean grad.	DVI
19 mm	<20 mmHg	>0.25
21 mm	<15 mmHg	>0.25
23 mm	<12 mmHg	>0.25
25 mm	<10 mmHg	>0.25

Aortic PPM	EOAI	Impact
None	>0.85	None
Moderate	0.65–0.85	High grad.
Severe	<0.65	Compromised

Prosthetic dysfunction

High grad + DVI >0.35 = PPM · High grad + DVI <0.25 = obstruction · Eccentric jet = paravalvular leak

Echocardiographic criteria — Amyloid

1. Concentric LVH ≥12mm no HTN · 2. Granular sparkling · 3. Early restrictive pattern · 4. Preserved EF · 5. Bi-atrial enlargement · 6. S' TDI <5 cm/s · 7. Pericardial effusion · 8. Thickened IAS

Apical Sparing — GLS

Impaired GLS (<−12%) with apical sparing. GLS apex/base ratio >1 = pathognomonic. E/e' >15–20 = advanced amyloid.

Criterion	HTN	HCM	Amyloid
IVS thickness	12–15mm	>15 asym.	15–20 conc.
Apical sparing	No	No	Yes ✓
S' TDI	Normal	Preserved	<5 cm/s
SAM / gradient	No	Yes	No

Pericardial effusion

Small	<10 mm
Moderate	10–20 mm
Large	>20 mm

Tamponade

RA systolic collapse · RV diastolic collapse · IVC >21mm non-collapsible · Resp. variation mitral flow >25% · Swinging heart

Constrictive pericarditis

Septal e' > lateral e' (annulus reversus) · Inspiratory septal bounce · Dilated IVC · TDI e' preserved (>7) vs restrictive CMP

Normal aortic dimensions

Aortic annulus	18–25 mm
Sinus of Valsalva	29–45 mm M / 26–39 F
Sinotubular junct.	<36 mm M / <32 F
Ascending aorta	<40 mm (<21 mm/m²)
Desc. aorta	<30 mm

Surgical thresholds (ESC 2024)

Ascending Ao >55 mm · >50 mm if bicuspid or Marfan · >45 mm if Marfan + risk factors

Left atrium & IVC

Normal LA vol.	<34 mL/m²
Mildly enlarged LA	34–41 mL/m²
Mod. enlarged LA	42–48 mL/m²
Severely enlarged LA	>48 mL/m²
Normal IVC	<21 mm + collapse >50%

Echocardiographic views — TTE and TEE

View examples coming soon

Reference images for each view will be added soon.

Parasternal window

Long axis (PLAX)	LV, LVOT, AoV, MV
Short axis base	AoV, PA, RA, LA, RV
Short axis mitral	Mitral valve
Short axis mid	LV wall motion, IVS

Apical window

4-chamber (A4C)	LV, RV, LA, RA, AV valves
5-chamber (A5C)	+ LVOT, AoV, VTI
2-chamber (A2C)	LV, LA, MV
3-chamber (A3C)	LV, LVOT, AoV

Subcostal window

SC 4-chamber	Pericardium, RV, septum
IVC + hepatics	Diameter, collapsibility
Abdominal aorta	Aneurysm, dissection

Key measurements

Biplane Simpson EF	A4C + A2C
LVOT VTI	A5C, pulsed Doppler
Mitral E/A + TDI	A4C
TAPSE	A4C, M-mode
Peak TR + SPAP	A4C or parasternal
VCI / IVC	Subcostal

View examples coming soon

TEE reference view images will be added soon.

Oesophageal views (30–40 cm)

4-chamber (0°)	LV, RV, LA, RA
2-chamber (90°)	LV, LA, MV
Long axis (120–135°)	LV, LVOT, AoV
AoV short axis	Tricuspid AoV
SVC (90°)	Preload, collapsibility

Transgastric views (40–45 cm)

LV short axis (0°)	LV wall motion
TG long axis	LVOT, VTI, CO

ICU TEE indications

Undifferentiated shock	Poor TTE window
Aortic dissection	Diagnostic emergency
Endocarditis	Vegetations, abscess
LA appendage thrombus	Before cardioversion

Practical TTE tips

Left lateral decubitus → better apical window · Held expiration → parasternal · A4C: probe toward right shoulder · Subcostal: probe flat, end-expiratory apnoea

Common beginner pitfalls

Do not confuse RV (triangular, right of screen) and LV in A4C · Apex must be at image centre · Always check probe orientation

TEE landmarks — depth

25–30 cm	Descending aorta
30–35 cm	Base, AoV, atria
35–40 cm	4-chamber, AV valves
40–45 cm	Transgastric (ant. flex.)

Fluid responsiveness — Indices and protocols

When to assess fluid responsiveness?

Before any fluid challenge in shock. The goal is to predict whether cardiac output will increase by ≥10% after 500 mL crystalloid.

Dynamic indices — spontaneous breathing (SB)

PLR + LVOT VTI	↑ ≥10% = responder
IVC inspi (SB)	↓ >18% = responder
CO = VTI × HR	↑ ≥10% = responder

Dynamic indices — controlled ventilation (CMV)

PPV (CMV)	>13% = responder
SVV (CMV)	>10–12% = responder
SVC collapsibility (TEE)	>36% = responder

Condition	Preferred method
SB, sinus rhythm	PLR + VTI or IVC
CMV, Vt ≥8 mL/kg	PPV, SVV
CMV, intubated, TEE	SVC >36%
AF, low Vt, PAH	PLR + VTI (avg 5 cycles)

Contraindications & limitations

PLR: raised ICP, lower limb fracture, tamponade · PPV/SVV: AF, Vt <8mL/kg, severe PAH, spontaneous breaths · Severe RV failure: no parameter reliable

PLR Protocol

1. Semi-recumbent 45° — measure baseline VTI · 2. Passive tilt to supine, legs at 45° · 3. Measure VTI within 60 seconds · 4. Interpret: ↑ ≥10% = responder

Baseline LVOT VTI (cm)

Post-PLR LVOT VTI (cm)

Guided timer

Waiting

1:00

Enter baseline and post-PLR VTI, then start the timer.

SVC collapsibility (TEE — Gold standard CMV)

High oesophageal view 90°. Measure max (expiration) and min (inspiration) diameter. Formula: (Dmax − Dmin) / Dmax × 100. Threshold >36% = responder.

SVC Dmax — expiration (mm)

SVC Dmin — inspiration (mm)

IVC collapsibility (TTE — Spontaneous breathing)

Subcostal view. Measure Dmax (expiration) and Dmin (inspiration). CI = (Dmax − Dmin) / Dmax × 100. Threshold >50% (SB) = fluid responder.

IVC Dmax — expiration (mm)

IVC Dmin — inspiration (mm)

Generate an echocardiographic report

Examination (anonymous)

Anonymous report — no identifying data

Exam date

Indication

Rhythm

HR (bpm)

Quality

Sex

Left ventricle

EDD (mm) N:42–58M

ESD (mm) N:25–40

IVS (mm) N:6–10

PW (mm) N:6–10

LVEF (%) N:>52M

EF method

MAPSE (mm) N:>8

Lateral S' N:>7

Segmental wall motion

LV comment

Cardiac output

CO = LVOT VTI × π × (LVOT D/2)² × HR | Normal: 4–8 L/min

LVOT VTI (cm)

LVOT diam. (mm) N:18–25

HR for CO calculation (bpm)

Diastolic function

E wave (cm/s)

A wave (cm/s)

E/A

DT (ms)

Septal e' N:>7

Lateral e' N:>10

Mean E/e' N:<8

LA vol. (mL/m²) N:<34

Diastolic dysfunction grade

Diastole comment

RV & Pulmonary pressures

RV basal diam. N:<41

TAPSE (mm) N:≥17

Tricuspid S' N:≥10

FAC (%) N:>35

Peak TR vel. N:<2.8

Est. SPAP (mmHg)

IVC (mm) N:<21

IVC collapsibility

Acute cor pulmonale / PE signs

McConnell sign Paradoxical septum RV/RA thrombus RV > LV

Valves

Mitral valve

Morphology

MR / IM

Aortic valve

Ao Vmax (m/s)

Mean gradient (mmHg)

AVA (cm²)

AI / AR

IT / TR

Pericardium & Aorta

Pericardial effusion

Tamponade

Ascending Ao (mm) N:<40

Sinus Valsalva (mm)

Notable findings

Vegetation ASD / shunt Thrombus Mass / tumour

Comment

Conclusion

Generated report

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About SONIC

SONIC

SONography In Critical care

Authors

Clément Brault Médecine Intensive — Réanimation
Valentin Dambrine Médecine Intensive — Réanimation
Yoann Zerbib Médecine Intensive — Réanimation

Affiliation

CHU Amiens-Picardie
Amiens, France

Application

Version	1.0
Standards	ASE / ESC 2022
Usage	Decision support

Disclaimer

This application is a clinical decision support tool. It does not replace the clinical judgment of the practitioner or the recommendations of learned societies.

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