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Gustav Smith

Associate professor

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Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation


  • Annika Ingvarsson
  • Anna Werther Evaldsson
  • Johan Waktare
  • Johan Nilsson
  • Gustav J. Smith
  • Martin Stagmo
  • Anders Roijer
  • Göran Rådegran
  • Carl J. Meurling

Summary, in English

Background: Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients. Methods: The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects. Results: Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [. P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [. P < .0001], fractional area change 40 ± 8% [. P < .0001], and RV free wall strain -16.9 ± 4.2% [. P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection. Conclusion: The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.


  • EXODIAB: Excellence of Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health
  • Cardiology
  • Thoracic Surgery
  • Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS)
  • Cardiology Research Group

Publishing year







Journal of the American Society of Echocardiography





Document type

Journal article




  • Cardiac and Cardiovascular Systems


  • Allograft
  • Heart transplantation
  • Speckle-tracking
  • Strain
  • Two-dimensional echocardiography



Research group

  • Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS)
  • Cardiology Research Group


  • ISSN: 0894-7317