Aortic insufficiency stages: Difference between revisions
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{{Aortic insufficiency}} | |||
==Overview== | ==Overview== | ||
According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, [[aortic insufficiency]] | According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, [[aortic insufficiency]] is classified into 4 stages based on the valve's anatomy, hemodynamics, and the patients symptoms. | ||
==Stages== | ==Stages== | ||
Shown below is a table summarizing the stages of [[aortic regurgitation]] (AR) according to the 2014 AHA/ACC | Shown below is a table summarizing the stages of [[aortic regurgitation]] (AR) according to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=R. A.|last2=Otto|first2=C. M.|last3=Bonow|first3=R. O.|last4=Carabello|first4=B. A.|last5=Erwin|first5=J. P.|last6=Guyton|first6=R. A.|last7=O'Gara|first7=P. T.|last8=Ruiz|first8=C. E.|last9=Skubas|first9=N. J.|last10=Sorajja|first10=P.|last11=Sundt|first11=T. M.|last12=Thomas|first12=J. D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000031}}</ref> <ref name="pmid27106040">{{cite journal| author=Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A| title=The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis. | journal=Am J Physiol Heart Circ Physiol | year= 2016 | volume= 310 | issue= 11 | pages= H1801-7 | pmid=27106040 | doi=10.1152/ajpheart.00161.2016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27106040 }} </ref> <ref name="pmid15470217">{{cite journal| author=Enriquez-Sarano M, Tajik AJ| title=Clinical practice. Aortic regurgitation. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 15 | pages= 1539-46 | pmid=15470217 | doi=10.1056/NEJMcp030912 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15470217 }} </ref><ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref> <ref name="pmid19564568">{{cite journal| author=Stout KK, Verrier ED| title=Acute valvular regurgitation. | journal=Circulation | year= 2009 | volume= 119 | issue= 25 | pages= 3232-41 | pmid=19564568 | doi=10.1161/CIRCULATIONAHA.108.782292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19564568 }} </ref> | ||
<span style="font-size:85%">'''Abbreviations:''' '''AR''': aortic regurgitation | <span style="font-size:85%">'''Abbreviations:''' '''AR''': aortic regurgitation; '''HF''': heart failure; '''IE''': infective endocarditis; '''LV''': left ventricular; '''LVEF''': left ventricular ejection fraction; '''LVESD''': left ventricular end-systolic dimension; '''LVOT''': left ventricular outflow tract; '''Jet/LVOT''' : jet width and LVOT ratio</span> | ||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
! STAGE | ! style="background: #4479BA; color: #F8F8FF"|STAGE | ||
! DEFINITION | ! style="width: 100px;background: #4479BA; color: #F8F8FF"|DEFINITION | ||
! VALVE ANATOMY | ! style="width: 150px;background: #4479BA; color: #F8F8FF"|SYMPTOMS | ||
! VALVE HEMODYNAMICS | ! style="width: 200px;background: #4479BA; color: #F8F8FF"|VALVE ANATOMY | ||
! HEMODYNAMIC CONSEQUENCES | ! style="width: 300px;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 [[AR]] | | At risk of [[AR]] | ||
| | | • None | ||
| | | • Bicuspid valve <br> • Valve [[sclerosis]] <br> • History of [[rheumatic fever]] <br> • [[Infective endocarditis]] | ||
| • '''No regurgitation''' | |||
| | | • None | ||
|- | |- | ||
| B | | style="background: #4479BA; color: #F8F8FF"|'''B''' | ||
| Progressive [[AR]] | | Progressive [[AR]] | ||
| | | • None | ||
<br> | | • Mild-to-moderate calcification <br> • Rheumatic valve changes <br> • Dilatation of aortic sinuses <br> • [[Infective endocarditis]] | ||
| | | • '''Mild regurgitation''': | ||
: | : • Jet/LVOT <25% | ||
: | : • [[Vena contracta]] <0.3 cm | ||
: | : • Regurgitant volume <30 mL/beat | ||
: | : • Regurgitant fraction <30% | ||
: | : • Effective regurgitant orifice <0.10 cm² | ||
<br> | : • [[Aortography|Angiography]] grade 1+ | ||
: | <br> • '''Moderate regurgitation''': | ||
: | : • Jet/LVOT: 25%–64% | ||
: | : • [[Vena contracta]] 0.3–0.6 cm | ||
: | : • Regurgitant volume 30–59 mL/beat | ||
: | : • Regurgitant fraction 30%–49% | ||
: | : • Effective regurgitant orifice 0.10–0.29 cm² | ||
| | : • [[Aortography|Angiography]] grade 2+ | ||
| • Normal LV systolic function <br> • Normal LV volume or mild LV dilation | |||
|- | |- | ||
| C | | style="background: #4479BA; color: #F8F8FF"|'''C''' | ||
| Asymptomatic severe | | Asymptomatic severe | ||
| | | • None <br> • Exercise testing to confirm symptom status | ||
| | | • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Bicuspid valve <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | ||
: | | • '''Severe regurgitation''' | ||
: | : • Jet/LVOT ≥65% | ||
: | : • [[Vena contracta]] >0.6 cm; | ||
: | : • Holodiastolic flow reversal in the proximal abdominal aorta | ||
: | : • Regurgitant volume ≥60 mL/beat; | ||
: | : • Regurgitant fraction ≥50%; | ||
: | : • Effective regurgitant orifice ≥0.3 cm2; | ||
| | : • [[Aortography|Angiography]] grade 3+ to 4+; | ||
| • '''C1:''' Normal [[LVEF]] and mild to moderate LV dilatation <br> <br> | |||
---- | |||
• '''C2:''' LV systolic dysfunction with decreased LVEF or severe LV dilatation | |||
|- | |- | ||
| D | | style="background: #4479BA; color: #F8F8FF"|'''D''' | ||
| Symptomatic severe [[ | | Symptomatic severe | ||
| | | • Exertional [[dyspnea]] <br> • Exertional [[angina]] <br> • [[HF]] symptoms | ||
<br> | | • Calcific aortic valve disease <br> • Rheumatic valve changes <br> • Dilated aortic sinuses <br> • [[Infective endocarditis]] with abnormal leaflet closure | ||
| | | | | • '''Severe regurgitation''' | ||
: | : • Jet/LVOT ≥65% | ||
: | : • [[Vena contracta]] >0.6 cm; | ||
: | : • Holodiastolic flow reversal in the proximal abdominal aorta | ||
: | : • Regurgitant volume ≥60 mL/beat; | ||
: | : • Regurgitant fraction ≥50%; | ||
: | : • Effective regurgitant orifice ≥0.3 cm2; | ||
: | : • [[Aortography|Angiography]] grade 3+ to 4+; | ||
| | | • Normal or decreased systolic function <br> • Moderate to severe LV dilatation | ||
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==References== | ==References== | ||
{{reflist|1}} | {{reflist|1}} | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Cardiac surgery]] | [[Category:Cardiac surgery]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 04:34, 7 July 2020
Resident Survival Guide |
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]
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Overview
According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, aortic insufficiency is classified into 4 stages based on the valve's anatomy, hemodynamics, and the patients symptoms.
Stages
Shown below is a table summarizing the stages of aortic regurgitation (AR) according to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.[1] [2] [3][4] [5]
Abbreviations: AR: aortic regurgitation; HF: heart failure; IE: infective endocarditis; LV: left ventricular; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic dimension; LVOT: left ventricular outflow tract; Jet/LVOT : jet width and LVOT ratio
STAGE | DEFINITION | SYMPTOMS | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES |
---|---|---|---|---|---|
A | At risk of AR | • None | • Bicuspid valve • Valve sclerosis • History of rheumatic fever • Infective endocarditis |
• No regurgitation | • None |
B | Progressive AR | • None | • Mild-to-moderate calcification • Rheumatic valve changes • Dilatation of aortic sinuses • Infective endocarditis |
• Mild regurgitation:
|
• Normal LV systolic function • Normal LV volume or mild LV dilation |
C | Asymptomatic severe | • None • Exercise testing to confirm symptom status |
• Calcific aortic valve disease • Rheumatic valve changes • Bicuspid valve • Dilated aortic sinuses • Infective endocarditis with abnormal leaflet closure |
• Severe regurgitation
|
• C1: Normal LVEF and mild to moderate LV dilatation • C2: LV systolic dysfunction with decreased LVEF or severe LV dilatation |
D | Symptomatic severe | • Exertional dyspnea • Exertional angina • HF symptoms |
• Calcific aortic valve disease • Rheumatic valve changes • Dilated aortic sinuses • Infective endocarditis with abnormal leaflet closure |
• Severe regurgitation
|
• Normal or decreased systolic function • Moderate to severe LV dilatation
|
References
- ↑ Nishimura, R. A.; Otto, C. M.; Bonow, R. O.; Carabello, B. A.; Erwin, J. P.; Guyton, R. A.; O'Gara, P. T.; Ruiz, C. E.; Skubas, N. J.; Sorajja, P.; Sundt, T. M.; Thomas, J. D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.
- ↑ Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A (2016). "The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis". Am J Physiol Heart Circ Physiol. 310 (11): H1801–7. doi:10.1152/ajpheart.00161.2016. PMID 27106040.
- ↑ Enriquez-Sarano M, Tajik AJ (2004). "Clinical practice. Aortic regurgitation". N Engl J Med. 351 (15): 1539–46. doi:10.1056/NEJMcp030912. PMID 15470217.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
- ↑ Stout KK, Verrier ED (2009). "Acute valvular regurgitation". Circulation. 119 (25): 3232–41. doi:10.1161/CIRCULATIONAHA.108.782292. PMID 19564568.