Aortic stenosis stages: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{Aortic stenosis}} | ||
{{CMG}} {{AE}} {{AL}}; {{USAMA}} | |||
==Overview== | ==Overview== | ||
[[Aortic stenosis]] can be classified into 7 stages based on the valve's anatomy and hemodynamics as well as the patients symptoms. | |||
==Stages== | ==Stages== | ||
Shown below is a table summarizing the stages of aortic stenosis (AS) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease.<ref>{{Cite web | last = | first = | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher = | date = | accessdate = 4 March 2014 }}</ref> | |||
<span style="font-size:85%">'''Abbreviations:''' '''AR:''' Aortic regurgitation; '''AS:''' Aortic stenosis; '''AVA:''' Aortic valve area; '''LV:''' Left ventricle; '''LVEF:''' Left ventricular ejection fraction </span> | |||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
! STAGE | ! style="background: #4479BA; color: #F8F8FF"|STAGE | ||
! DEFINITION | ! style="width: 200px;background: #4479BA; color: #F8F8FF"| DEFINITION | ||
! VALVE ANATOMY | ! style="width: 200px;background: #4479BA; color: #F8F8FF"| SYMPTOMS | ||
! VALVE HEMODYNAMICS | ! style="width: 200px;background: #4479BA; color: #F8F8FF"| VALVE ANATOMY | ||
! HEMODYNAMIC CONSEQUENCES | ! style="width: 200px;background: #4479BA; color: #F8F8FF"| VALVE HEMODYNAMICS | ||
! style="width: 200px;background: #4479BA; color: #F8F8FF"| HEMODYNAMIC CONSEQUENCES | |||
|- | |- | ||
| A | | style="background: #4479BA; color: #F8F8FF"|'''A''' | ||
| At risk of AS | | At risk of [[aortic stenosis|AS]] | ||
| | | • None | ||
| Vmax < 2 m/s | | • Bicuspid valve <br> • Valve [[sclerosis]] | ||
| | | • Vmax < 2 m/s | ||
| • None | |||
|- | |- | ||
| | | style="background: #4479BA; color: #F8F8FF"|'''B''' | ||
| | | Progressive [[aortic stenosis|AS]] | ||
| • None | |||
| • Mild-to-moderate calcification <br> • Rheumatic valve changes with commissural fusion | |||
| • Mild [[aortic stenosis|AS]]: Vmax = 2.0-2.9 m/s or mean ΔP < 20 mmHg <br> • Moderate AS: Vmax = 3.0-3.9 m/s or mean ΔP 20-39 mmHg | |||
| • Early LV [[diastolic dysfunction]] may be present <br> • Normal [[LVEF]] | |||
|- | |- | ||
| | | style="background: #4479BA; color: #F8F8FF"|'''C1''' | ||
| Asymptomatic severe AS with LV dysfunction | | Asymptomatic severe [[aortic stenosis|AS]] | ||
| • None <br> • Exercise testing to confirm symptom status | |||
| • Severe calcification or congenital stenosis with severely reduced opening | |||
| • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg <br> • Very severe [[aortic stenosis|AS]] is a Vmax ≥ m/s or mean ΔP ≥ 60 mmHg | |||
| • LV diastolic dysfunction <br> • Mild left ventricular hypertrophy <br> • Normal LVEF | |||
|- | |- | ||
| | | style="background: #4479BA; color: #F8F8FF"|'''C2''' | ||
| | | Asymptomatic severe [[aortic stenosis|AS]] with LV dysfunction | ||
| • None | |||
| • Severe calcification or congenital stenosis with severely reduced opening | |||
| • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg <br> • AVA ≤ 1.0 cm² | |||
| • [[LVEF]] < 50% | |||
|- | |- | ||
| | | style="background: #4479BA; color: #F8F8FF"|'''D1''' | ||
| Symptomatic severe | | Symptomatic severe high-gradient [[aortic stenosis|AS]] | ||
| • Exertional [[dyspnea]] or decreased exercise tolerance <br> • Exertional [[angina]] <br> • Exertional [[syncope]] or presyncope | |||
| • Severe calcification or congenital stenosis with severely reduced opening | |||
| • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg <br> • AVA ≤ 1.0 cm² but may be larger with mixed [[aortic stenosis|AS]] and [[AR]] | |||
| • LV [[diastolic dysfunction]] <br> • [[Left ventricular hypertrophy]] <br> • May present with [[pulmonary hypertension]] | |||
|- | |- | ||
| | | style="background: #4479BA; color: #F8F8FF"|'''D2''' | ||
| | | Symptomatic severe low-flow/low gradient AS with reduced [[LVEF]] | ||
| • [[Heart failure]] <br> • [[Angina]] <br> • [[Syncope]] or presyncope | |||
| • Severe calcification or congenital stenosis with severely reduced leaflet motion | |||
| • AVA ≤ 1.0 cm² with resting aortic Vmax < 4 m/s or mean ΔP ≥ 40 mmHg <br> • Dobutamine stress echo shows AVA ≤ 1.0 cm² with Vmax ≥ 4 m/s at any flow rate | |||
| • LV diastolic dysfunction <br> • [[Left ventricular hypertrophy]] <br> • [[LVEF]] <50% | |||
|- | |- | ||
| style="background: #4479BA; color: #F8F8FF"|'''D3''' | |||
| Symptomatic severe low gradient with normal [[LVEF]] | |||
| • [[Heart failure]] <br> • [[Angina]] <br> • [[Syncope]] or presyncope | |||
| • Severe calcification with severely reduced leaflet motion | |||
| • AVA ≤ 1.0 cm² with Vmax < 4 m/s or mean ΔP ≤ 40 mmHg <br> • AVA ≤ 0.6 cm² <br> • Stroke volume index < 35 mL/m² | |||
| • Increased LV relative wall thickness <br> • Small LV chamber with low stroke volume <br> • Restrictive diastolic filling <br> • [[LVEF]] ≥ 50% | |||
|} | |} | ||
==References== | ==References== | ||
{{reflist| | {{reflist|1}} | ||
{{WH}} | |||
{{WS}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Cardiac surgery]] | [[Category:Cardiac surgery]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 16:02, 5 January 2017
Aortic Stenosis Microchapters |
Diagnosis |
---|
Treatment |
Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
Transcatheter Aortic Valve Replacement (TAVR) |
Case Studies |
Aortic stenosis stages On the Web |
American Roentgen Ray Society Images of Aortic stenosis stages |
Risk calculators and risk factors for Aortic stenosis stages |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Usama Talib, BSc, MD [3]
Overview
Aortic stenosis can be classified into 7 stages based on the valve's anatomy and hemodynamics as well as the patients symptoms.
Stages
Shown below is a table summarizing the stages of aortic stenosis (AS) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease.[1]
Abbreviations: AR: Aortic regurgitation; AS: Aortic stenosis; AVA: Aortic valve area; LV: Left ventricle; LVEF: Left ventricular ejection fraction
STAGE | DEFINITION | SYMPTOMS | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES |
---|---|---|---|---|---|
A | At risk of AS | • None | • Bicuspid valve • Valve sclerosis |
• Vmax < 2 m/s | • None |
B | Progressive AS | • None | • Mild-to-moderate calcification • Rheumatic valve changes with commissural fusion |
• Mild AS: Vmax = 2.0-2.9 m/s or mean ΔP < 20 mmHg • Moderate AS: Vmax = 3.0-3.9 m/s or mean ΔP 20-39 mmHg |
• Early LV diastolic dysfunction may be present • Normal LVEF |
C1 | Asymptomatic severe AS | • None • Exercise testing to confirm symptom status |
• Severe calcification or congenital stenosis with severely reduced opening | • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg • Very severe AS is a Vmax ≥ m/s or mean ΔP ≥ 60 mmHg |
• LV diastolic dysfunction • Mild left ventricular hypertrophy • Normal LVEF |
C2 | Asymptomatic severe AS with LV dysfunction | • None | • Severe calcification or congenital stenosis with severely reduced opening | • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg • AVA ≤ 1.0 cm² |
• LVEF < 50% |
D1 | Symptomatic severe high-gradient AS | • Exertional dyspnea or decreased exercise tolerance • Exertional angina • Exertional syncope or presyncope |
• Severe calcification or congenital stenosis with severely reduced opening | • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg • AVA ≤ 1.0 cm² but may be larger with mixed AS and AR |
• LV diastolic dysfunction • Left ventricular hypertrophy • May present with pulmonary hypertension |
D2 | Symptomatic severe low-flow/low gradient AS with reduced LVEF | • Heart failure • Angina • Syncope or presyncope |
• Severe calcification or congenital stenosis with severely reduced leaflet motion | • AVA ≤ 1.0 cm² with resting aortic Vmax < 4 m/s or mean ΔP ≥ 40 mmHg • Dobutamine stress echo shows AVA ≤ 1.0 cm² with Vmax ≥ 4 m/s at any flow rate |
• LV diastolic dysfunction • Left ventricular hypertrophy • LVEF <50% |
D3 | Symptomatic severe low gradient with normal LVEF | • Heart failure • Angina • Syncope or presyncope |
• Severe calcification with severely reduced leaflet motion | • AVA ≤ 1.0 cm² with Vmax < 4 m/s or mean ΔP ≤ 40 mmHg • AVA ≤ 0.6 cm² • Stroke volume index < 35 mL/m² |
• Increased LV relative wall thickness • Small LV chamber with low stroke volume • Restrictive diastolic filling • LVEF ≥ 50% |
References
- ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.