Aortic insufficiency stages: Difference between revisions
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Shown below is a table summarizing the stages of [[aortic regurgitation]] (AR) 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> | Shown below is a table summarizing the stages of [[aortic regurgitation]] (AR) 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 | <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" | ||
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| A | | A | ||
| At risk of [[AR]] | | At risk of [[AR]] | ||
| ❑ Bicuspid valve <br> ❑ Valve [[ | | ❑ Bicuspid valve <br> ❑ Valve [[sclEffective regurgitant orificesis]] <br> ❑ History of [[rheumatic fever]] <br> ❑ [[Infective endocarditis]] | ||
| ❑ None | | ❑ None | ||
| ❑ None | | ❑ None | ||
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: ❑ Jet/LVOT <25% | : ❑ Jet/LVOT <25% | ||
: ❑ [[Vena contracta]] <0.3 cm | : ❑ [[Vena contracta]] <0.3 cm | ||
: ❑ | : ❑ Regurgitant volume <30 mL/beat | ||
: ❑ Regurgitant fraction <30% | : ❑ Regurgitant fraction <30% | ||
: ❑ | : ❑ Effective regurgitant orifice <0.10 cm² | ||
: ❑ [[Aortography|Angiography]] grade 1+ | : ❑ [[Aortography|Angiography]] grade 1+ | ||
<br> ❑ Moderate [[AR]]: | <br> ❑ Moderate [[AR]]: | ||
: ❑ Jet/LVOT: 25%–64% | : ❑ Jet/LVOT: 25%–64% | ||
: ❑ [[Vena contracta]] 0.3–0.6 cm | : ❑ [[Vena contracta]] 0.3–0.6 cm | ||
: ❑ | : ❑ Regurgitant volume 30–59 mL/beat | ||
: ❑ Regurgitant fraction 30%–49% | : ❑ Regurgitant fraction 30%–49% | ||
: ❑ | : ❑ Effective regurgitant orifice 0.10–0.29 cm² | ||
: ❑ [[Aortography|Angiography]] grade 2+ | : ❑ [[Aortography|Angiography]] grade 2+ | ||
| ❑ Normal LV systolic function <br> ❑ Normal LV volume or mild LV dilation | | ❑ Normal LV systolic function <br> ❑ Normal LV volume or mild LV dilation | ||
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: ❑ [[Vena contracta]] >0.6 cm; | : ❑ [[Vena contracta]] >0.6 cm; | ||
: ❑ Holodiastolic flow reversal in the proximal abdominal aorta | : ❑ Holodiastolic flow reversal in the proximal abdominal aorta | ||
: ❑ | : ❑ Regurgitant volume ≥60 mL/beat; | ||
: ❑ Regurgitant fraction ≥50%; | : ❑ Regurgitant fraction ≥50%; | ||
: ❑ | : ❑ Effective regurgitant orifice ≥0.3 cm2; | ||
: ❑ [[Aortography|Angiography]] grade 3+ to 4+; | : ❑ [[Aortography|Angiography]] grade 3+ to 4+; | ||
| ❑ C1: Normal [[LVEF]] and mild to moderate LV dilatation <br> <br> ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation | | ❑ C1: Normal [[LVEF]] and mild to moderate LV dilatation <br> <br> ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation | ||
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: ❑ [[Vena contracta]] >0.6 cm; | : ❑ [[Vena contracta]] >0.6 cm; | ||
: ❑ Holodiastolic flow reversal in the proximal abdominal aorta | : ❑ Holodiastolic flow reversal in the proximal abdominal aorta | ||
: ❑ | : ❑ Regurgitant volume ≥60 mL/beat; | ||
: ❑ Regurgitant fraction ≥50%; | : ❑ Regurgitant fraction ≥50%; | ||
: ❑ | : ❑ Effective regurgitant orifice ≥0.3 cm2; | ||
: ❑ [[Aortography|Angiography]] grade 3+ to 4+; | : ❑ [[Aortography|Angiography]] grade 3+ to 4+; | ||
| ❑ May occur with normal systolic function or decreased function <br> ❑ Presence of moderate to severe LV dilatation | | ❑ May occur with normal systolic function or decreased function <br> ❑ Presence of moderate to severe LV dilatation |
Revision as of 19:42, 9 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, aortic insufficiency has 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 guidelines for the management of patients with valvular heart disease. [1]
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 | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
---|---|---|---|---|---|
A | At risk of AR | ❑ Bicuspid valve ❑ Valve sclEffective regurgitant orificesis ❑ History of rheumatic fever ❑ Infective endocarditis |
❑ None | ❑ None | ❑ None |
B | Progressive AR | ❑ Mild-to-moderate calcification ❑ Rheumatic valve changes
|
❑ Mild AR:
|
❑ Normal LV systolic function ❑ Normal LV volume or mild LV dilation |
❑ None |
C | Asymptomatic severe AR | ❑ Calcific aortic valve disease ❑ Rheumatic valve changes ❑ Bicuspid valve ❑ Dilated aortic sinuses ❑ Infective endocarditis with abnormal leaflet closure |
❑ Severe AR
|
❑ C1: Normal LVEF and mild to moderate LV dilatation ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation |
❑ None ❑ Exercise testing to confirm symptom status |
D | Symptomatic severe AR | ❑ Calcific aortic valve disease ❑ Rheumatic valve changes
|
❑ Severe AR
|
❑ May occur with normal systolic function or decreased function ❑ Presence of moderate to severe LV dilatation |
❑ Exertional dyspnea ❑ Exertional angina ❑ HF symptoms
|
References
- ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.