Cardiovascular Disease: Valvular Heart Disease

sec_arr Table 3: Staging of Aortic Stenosis (AS)*


Stage  Definition  Aortic Valve (AV) Anatomy  AV Hemodynamics  Hemodynamic Consequences  Symptoms 
At risk of AS  -AV sclerosis 

-Bicuspid AV 

-Congenital AV anomaly  

-AV Vmax <2 m/s 

-Normal leaflet motion 


None  None 
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 

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 

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 


-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:, accessed 1/16/2024. 

** Exercise testing is reasonable to confirm symptom status.