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Eur Heart J Cardiovasc Imaging. 2018 Jun 1;19(6):630-638. doi: 10.1093/ehjci/jey018.

Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study.

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Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.
Cardiology Department, CHU Tours, France et Université de Tours, 2 Boulevard Tonnellé, 37000 Tours, France.
Department of Medicine University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, 60637 IL, USA.
Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain.
Echocardiography Laboratory of Adult Cardiology Department of the JO ANN Medical Center, 21 Lubliana str. 0159, Tbilisi, Georgia.
Noninvasive Diagnostics Department, Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, 176 74 Kallithea, Athens, Greece.
Laboratory of Cardiovascular Ecography, Cardiology Department, S. Andrea Hospital, Via Vittorio Veneto, 197, 19121 La Spezia SP, Italy.
Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana 'G.Monasterio'-Ospedale Del Cuore, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Massa, Italy.
Echocardiography Laboratory, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisboa, Portugal.
Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, ul. "Konyovitsa" 65, 1309 g.k. Ilinden, Sofia, Bulgaria.
Cardiology Department, La Paz Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain.
University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania.
Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan 164, 9300 Aalst, Belgium.
VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Tesvikiye, Güzelbahçe Sk. No:20, 34365 Sisli/Istanbul, Turkey.
Laboratorio de Ecocardiografia Hospital de Cruces, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya, Spain.
Echocardiography Unit, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000 Gent, Belgium.
Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania.
University Alcala, Hospital Ramón y Cajal, Ctra. De Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain.
CHU Dupuytren, 2 Avenue Martin Luther King, 87000 Limoges, France.
CHVZ (Centrum voor Hart en Vaatziekten), Universitair ziekenhuis Brussel and ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium.
CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France.
APHM, La Timone Hospital, Cardiology Department, Marseille France.
Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli NA, Italy.
Department of Cardiac, Thoracic and Vascular Sciences University of Padova, School of Medicine, Via 8 Febbraio 1848, 2, 35122 Padova PD, Italy.
Gruppo Villa Maria Care and Research, Anthea Hospital, Via Camillo Rosalba, 35, 70124 Bari BA, Italy.



To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender.

Methods and results:

A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS.


The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

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