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, 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 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: abnormal LV systolic function 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+;	• 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.

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

[1]

Aortic insufficiency stages

Overview

Stages

References

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