Aortic insufficiency stages

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 and hemodynamics and the patients symptoms.

Stages

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 ❑ Dilated aortic sinuses ❑ Infective endocarditis	❑ Mild AR: Jet width <25% of LVOT; Vena contracta <0.3 cm; RVol <30 mL/beat; RF <30%; ERO <0.10 cm²; Angiography grade 1+ ❑ Moderate AR: Jet width 25%–64% of LVOT; Vena contracta 0.3–0.6 cm; RVol 30–59 mL/beat; RF 30%–49%; ERO 0.10–0.29 cm²; Angiography grade 2+	❑ Normal LV systolic function ❑ Normal LV volume or mild LV dilation	❑ None
C	Asymptomatic severe AS	❑ Severe leaflet 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 LVH ❑ Normal LVEF	❑ None ❑ Exercise testing to confirm symptom status
D	Symptomatic severe high-gradient AS	❑ Severe leaflet 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 ❑ LVH ❑ May present with pulmonary hypertension	❑ Exertional dyspnea or decreased exercise tolerance ❑ Exertional angina ❑ Exertional syncope or presyncope

AVA: Aortic valve area; LV: Left ventricle