Aortic insufficiency stages: Difference between revisions

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|-
|-
! STAGE
! style="background: #4479BA; color: #F8F8FF"|STAGE
! DEFINITION
! style="width: 100px;background: #4479BA; color: #F8F8FF"|DEFINITION
! VALVE ANATOMY
! style="width: 200px;background: #4479BA; color: #F8F8FF"|VALVE ANATOMY
! VALVE HEMODYNAMICS
! style="width: 300px;background: #4479BA; color: #F8F8FF"|VALVE HEMODYNAMICS
! HEMODYNAMIC CONSEQUENCES
! style="width: 200px;background: #4479BA; color: #F8F8FF"|HEMODYNAMIC CONSEQUENCES
! SYMPTOMS
! style="width: 150px;background: #4479BA; color: #F8F8FF"|SYMPTOMS


|-
|-


| A
| style="background: #4479BA; color: #F8F8FF"|A
| At risk of [[AR]]
| At risk of [[AR]]
| ❑ Bicuspid valve <br>  ❑ Valve [[sclerosis]] <br>  ❑ History of [[rheumatic fever]] <br>  ❑ [[Infective endocarditis]]
| • Bicuspid valve <br>  • Valve [[sclerosis]] <br>  • History of [[rheumatic fever]] <br>  • [[Infective endocarditis]]
| ❑ None
| • None
| ❑ None
| • None
| ❑ None
| • None


|-
|-
| B
| style="background: #4479BA; color: #F8F8FF"|B
| Progressive [[AR]]
| Progressive [[AR]]
| ❑ Mild-to-moderate calcification  <br> ❑ Rheumatic valve changes <br> ❑ Dilatation of aortic sinuses <br>  ❑ [[Infective endocarditis]]
| • Mild-to-moderate calcification  <br> • Rheumatic valve changes <br> • Dilatation of aortic sinuses <br>  • [[Infective endocarditis]]
| ❑ Mild [[AR]]:   
| • Mild [[AR]]:   
: ❑ Jet/LVOT <25%  
: • Jet/LVOT <25%  
: ❑ [[Vena contracta]] <0.3 cm
: • [[Vena contracta]] <0.3 cm
: ❑ Regurgitant volume <30 mL/beat
: • Regurgitant volume <30 mL/beat
: ❑ Regurgitant fraction <30%
: • Regurgitant fraction <30%
: ❑ Effective regurgitant orifice <0.10 cm²
: • 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 volume 30–59 mL/beat
: ❑ Regurgitant fraction 30%–49%
: • Regurgitant fraction 30%–49%
: ❑ Effective regurgitant orifice 0.10–0.29 cm²
: • 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
| ❑ None
| • None


|-
|-
| C
| style="background: #4479BA; color: #F8F8FF"|C
| Asymptomatic severe [[AR]]
| Asymptomatic severe [[AR]]
| ❑ Calcific aortic valve disease  <br> ❑ Rheumatic valve changes  <br> ❑ Bicuspid valve <br> ❑ Dilated aortic sinuses <br>  ❑ [[Infective endocarditis]] with abnormal leaflet closure
| • Calcific aortic valve disease  <br> • Rheumatic valve changes  <br> • Bicuspid valve <br> • Dilated aortic sinuses <br>  • [[Infective endocarditis]] with abnormal leaflet closure
| ❑ Severe [[AR]]
| • Severe [[AR]]
: ❑ Jet/LVOT ≥65%
: • Jet/LVOT ≥65%
: ❑ [[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 volume ≥60 mL/beat;
: ❑ Regurgitant fraction ≥50%;
: • Regurgitant fraction ≥50%;
: ❑ Effective regurgitant orifice ≥0.3 cm2;
: • 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>
| ❑ None <br> ❑ Exercise testing to confirm symptom status
----
• C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation
| • None <br> • Exercise testing to confirm symptom status


|-
|-
| D
| style="background: #4479BA; color: #F8F8FF"|D
| Symptomatic severe [[AR]]
| Symptomatic severe [[AR]]
| ❑ Calcific aortic valve disease  <br> ❑ Rheumatic valve changes <br> ❑ Dilated aortic sinuses <br>  ❑ [[Infective endocarditis]] with abnormal leaflet closure
| • Calcific aortic valve disease  <br> • Rheumatic valve changes <br> • Dilated aortic sinuses <br>  • [[Infective endocarditis]] with abnormal leaflet closure
| | ❑ Severe [[AR]]
| | • Severe [[AR]]
: ❑ Jet/LVOT ≥65%
: • Jet/LVOT ≥65%
: ❑ [[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 volume ≥60 mL/beat;
: ❑ Regurgitant fraction ≥50%;
: • Regurgitant fraction ≥50%;
: ❑ Effective regurgitant orifice ≥0.3 cm2;
: • 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
| ❑ Exertional [[dyspnea]]  <br> ❑ Exertional [[angina]] <br> ❑ [[HF]] symptoms
| • Exertional [[dyspnea]]  <br> • Exertional [[angina]] <br> • [[HF]] symptoms




Revision as of 20:03, 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 sclerosis
• History of rheumatic fever
• Infective endocarditis 		• None • None • None
B Progressive AR • Mild-to-moderate calcification
• Rheumatic valve changes
• Dilatation of aortic sinuses
• Infective endocarditis 		• Mild AR:
• Jet/LVOT <25%
• Vena contracta <0.3 cm
• Regurgitant volume <30 mL/beat
• Regurgitant fraction <30%
• Effective regurgitant orifice <0.10 cm²
• Angiography grade 1+


• Moderate AR:

• 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
• Angiography grade 2+
 • 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
• 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;
• Angiography grade 3+ to 4+;
 • 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
• Dilated aortic sinuses
• Infective endocarditis with abnormal leaflet closure 		• Severe AR
• 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;
• Angiography grade 3+ to 4+;
 • May occur with normal systolic function or decreased function
• Presence of moderate to severe LV dilatation 		• Exertional dyspnea
• Exertional angina
• HF symptoms


References

  1. ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.

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