Cardiovascular Disease: Valvular Heart Disease
Table 3: Staging of Aortic Stenosis (AS)*
| Stage | Definition | Aortic Valve (AV) Anatomy | AV Hemodynamics | Hemodynamic Consequences | Symptoms |
| A | At risk of AS | -AV sclerosis
-Bicuspid AV -Congenital AV anomaly |
-AV Vmax <2 m/s
-Normal leaflet motion
|
None | None |
| B | Progressive AS | -Mild to moderate AV leaflet calcification or fibrosis
-Reduction in systolic motion |
-Aortic Vmax 2.0-3.9 m/s, or mean ΔP<39mm Hg
|
-Variable LV diastolic dysfunction
-Normal LVEF |
None |
| C | Asymptomatic severe AS with or without LV systolic dysfunction | Severe leaflet calcification, fibrosis, or congenital stenosis
-Severely reduced leaflet opening |
-Aortic Vmax ≥4.0 m/s, or mean ΔP≥39mm Hg | -LV diastolic dysfunction
-Mild LV hypertrophy -Variable LVEF |
None** |
| D | Symptomatic severe AS Includes:
-high gradient -low-flow, low-gradient, with reduced LVEF -low-flow, low gradient, with normal LVEF |
Same as C above |
Same as C above |
Same as C above | -Reduced exercise tolerance
-Exertional dyspnea, angina, presyncope, or syncope -Angina -Other symptoms of HF |
AS – Aortic stenosis; AV – aortic valve; ΔP – pressure gradient between the LV and aorta; HF – heart failure; LV – left ventricle; LVEF – left ventricular ejection fraction; Vmax – maximum velocity.
* Adapted and modified from Table 13. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2020;143(5):e72-e227. At: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923, accessed 1/16/2024.
** Exercise testing is reasonable to confirm symptom status.