Cardiovascular Disease: Valvular Heart Disease

sec_arr Table 4: Staging of Chronic Aortic Regurgitation*
Stage  Definition  Aortic Valve (AV) Anatomy  AV Hemodynamics  Hemodynamic Consequences  Symptoms 
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 
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 

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  

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:, accessed 1/16/2024. 

** Exercise testing is reasonable to confirm symptom status.