Aortic insufficiency stages: Difference between revisions

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==Stages==
==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]]. <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 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>


<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>
<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>

Revision as of 15:42, 11 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 		• No regurgitation • None • None
B Progressive AR • Mild-to-moderate calcification
• Rheumatic valve changes
• Dilatation of aortic sinuses
• 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
• Angiography grade 1+


• 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
• Angiography grade 2+
 • Normal LV systolic function
• Normal LV volume or mild LV dilation 		• None
C Asymptomatic severe • Calcific aortic valve disease
• Rheumatic valve changes
• Bicuspid valve
• Dilated aortic sinuses
• 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;
• Angiography grade 3+ to 4+;
 • C1: Normal LVEF and mild to moderate LV dilatation

• C2: LV systolic dysfunction with decreased LVEF or severe LV dilatation

• None
• Exercise testing to confirm symptom status
D Symptomatic severe • Calcific aortic valve disease
• Rheumatic valve changes
• Dilated aortic sinuses
• 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;
• Angiography grade 3+ to 4+;
 • Normal or decreased systolic function
• Moderate to severe LV dilatation 		• Exertional dyspnea
• Exertional angina
• HF symptoms


References

  1. ↑ 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.

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