Evidence map›Paper›PMID 42252391›Full record

ArticleEcho research and practice2026

Impact of guideline definitions on right ventricular diameter in echocardiography: an automated analysis in controls and patients with pulmonary hypertension.

Frida N Hermansson, Bettia E Celestin, Shadi P Bagherzadeh, Gracia Fahed, Everton J Santana, Neha Mantri, Roham T Zamanian, Alison L Marsden, Seraina A Dual, Michael Salerno and 1 more

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Article in Echo research and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Frida N HermanssonStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA. FridaHermansson@stanford.edu.ORCID http://orcid.org/0009-0009-3229-7682
Bettia E CelestinStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0009-0002-3499-6902
Shadi P BagherzadehStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
Gracia FahedStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0009-0007-3343-1156
Everton J SantanaStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.ORCID http://orcid.org/0000-0002-6014-9857
Neha MantriStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
Roham T ZamanianVera Moulton Wall Center for Pulmonary Disease, Stanford, CA, USA.
Alison L MarsdenStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
Seraina A DualDepartment of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.ORCID http://orcid.org/0000-0001-6867-8270
Michael SalernoDepartment of Medicine and Radiology, University of California, San Francisco, San Francisco, CA, USA.
Francois HaddadStanford Cardiovascular Institute, Stanford University, Stanford, CA, USA. fhaddad@stanford.edu.ORCID http://orcid.org/0000-0002-9648-7671

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo improve standardization, the 2025 American Association of Echocardiography (ASE) guidelines revised the definitions of right ventricular (RV) basal and mid diameters, revising the 2010 ASE and European Society of Cardiology (ESC) definitions.

objectives(1) To quantify differences in right ventricular (RV) diameter measurements between the 2010 and 2025 ASE guidelines, (2) to determine its impact on the diagnosis of RV enlargement (RVE), and (3) to compare these findings with a novel automated non-linear centerline-based approach.

methodsWe analyzed 208 healthy volunteers and 221 patients with pulmonary arterial hypertension (PAH). Using custom cardiac contour analysis (C2A) software, RV diameters were measured across three definitions. The 2010 ASE/ESC defines diameters as the maximal dimension in the basal and mid segments. In contrast, the 2025 ASE defines the basal diameter just below the tricuspid valve and the mid diameter at ~ 50% of RV inflow, both parallel to the annulus. The C2A method uses a non-linear RV centerline as a reference to standardize measurement locations: the mid-point is taken at 50% along the centerline, and the basal diameter is defined as the maximum perpendicular distance within the proximal third of the RV. We quantified nominal and relative definition differences and compared sex-specific RVE prevalence in healthy controls. Diagnostic performance (ROC) and outcome prediction (Cox models) are presented.

resultsThe median age was 63 years in healthy volunteers (52% male) and 48 years in patients with PAH (22% male), with a median pulmonary vascular resistance index (PVRI) of 22 Wood units·m². Compared to ASE/ESC 2010 definitions, ASE 2025 diameters were 15% (basal) and 20% (mid) lower. Using the 2025 definition in healthy controls, basal RVE was observed in 1% of females and 22% of males, while mid-RVE was present in 6% of females and 35.8% of males. The 2010 definition showed slightly better discrimination for PAH (AUC 0.937 vs. 0.898, p < 0.001). However, the prediction of outcomes was similar between the two definitions, with C-statistics of 0.59 (0.53–0.65) and 0.59 (0.53–0.66), respectively.

conclusionDifferences in guideline definitions of RV diameters are important to consider when implementing them in clinical practice.

Indexed as

Centerline methodEchocardiographyEngineeringGuidelinesPulmonary hypertensionReference valuesRight heartRight ventricleTransverse diameters

Identifiers

PMID42252391
PMCPMC13244954

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.