Cardiovascular Disease: Valvular Heart Disease
Table 4: Staging of Chronic Aortic Regurgitation*
| Stage | Definition | Aortic Valve (AV) Anatomy | AV Hemodynamics | Hemodynamic Consequences | Symptoms |
| A | At risk of AR | -Bicuspid AV
-Congenital AV anomaly -AV sclerosis -Diseases of the aortic sinuses or ascending aorta -History of rheumatic fever -Infectious endocarditis |
None or trace | None | None |
| B | Progressive AR | -Mild to moderate calcification of the AV
-Dilated aortic sinus -Rheumatic AV -Previous infective endocarditis |
-Doppler jet width <65% LVOT
-Vena contracta ≤0.6cm -Regurgitant volume <60ml -Regurgitant fraction <50% -ERO <30cm2 -Angiographic grade ≤2+ |
-Normal LV systolic function
-Normal LV volume or mild LV dilatation |
None |
| C | Asymptomatic severe AR | -Calcific AV disease
– Bicuspid AV -Congenital AV anomaly -Dilated aortic sinus -Dilated ascending aorta -Rheumatic AV -Infectious endocarditis with abnormal leaflet closure or perforation |
-Doppler jet width ≥65% LVOT
-Vena contracta >0.6cm -Regurgitant volume ≥60ml/beat -Regurgitant fraction ≥50% -ERO ≥30cm2 -Angiographic grade >2+ -Holodiastolic flow reversal in the proximal abdominal aorta -Evidence of LV dilation |
-Variable LVEF
-Variable LVESD |
None** |
| D | Symptomatic severe AR | Same as C above | Same as C above | Same as C above | -Exertional dyspnea
-Exertional angina -Other symptoms of HF |
AR – Aortic regurgitation; AV – aortic valve; ΔP – pressure gradient between the LV and aorta; ERO – Effective regurgitant orifice; HF – heart failure; LV – left ventricle; LVEF – left ventricular ejection fraction; LVOT – left ventricular outflow tract; Vmax – maximum velocity.
*Adapted and modified from Table 15. 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.