Health Dictionary

Overview

According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, aortic insufficiency is classified into 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 Guideline for the Management of Patients With Valvular Heart Disease.^[1] ^[2] ^[3]^[4] ^[5]

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	SYMPTOMS	VALVE ANATOMY	VALVE HEMODYNAMICS	HEMODYNAMIC CONSEQUENCES
A	At risk of AR	• None	• Bicuspid valve • Valve sclerosis • History of rheumatic fever • Infective endocarditis	• No regurgitation	• None
B	Progressive AR	• None	• 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
C	Asymptomatic severe	• None • Exercise testing to confirm symptom status	• 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
D	Symptomatic severe	• Exertional dyspnea • Exertional angina • HF symptoms	• 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

References

↑ 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.
↑ Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A (2016). “The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis”. Am J Physiol Heart Circ Physiol. 310 (11): H1801–7. doi:10.1152/ajpheart.00161.2016. PMID 27106040.
↑ Enriquez-Sarano M, Tajik AJ (2004). “Clinical practice. Aortic regurgitation”. N Engl J Med. 351 (15): 1539–46. doi:10.1056/NEJMcp030912. PMID 15470217.
↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (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”. J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
↑ Stout KK, Verrier ED (2009). “Acute valvular regurgitation”. Circulation. 119 (25): 3232–41. doi:10.1161/CIRCULATIONAHA.108.782292. PMID 19564568.

Cardiology

[NishimuraOtto2014-1] 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.

[pmid27106040-2] Okafor I, Raghav V, Midha P, Kumar G, Yoganathan A (2016). “The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis”. Am J Physiol Heart Circ Physiol. 310 (11): H1801–7. doi:10.1152/ajpheart.00161.2016. PMID 27106040.

[pmid15470217-3] Enriquez-Sarano M, Tajik AJ (2004). “Clinical practice. Aortic regurgitation”. N Engl J Med. 351 (15): 1539–46. doi:10.1056/NEJMcp030912. PMID 15470217.

[pmid24603191-4] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (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”. J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.

[pmid19564568-5] Stout KK, Verrier ED (2009). “Acute valvular regurgitation”. Circulation. 119 (25): 3232–41. doi:10.1161/CIRCULATIONAHA.108.782292. PMID 19564568.

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Health Dictionary

Aortic regurgitation stages

Introduction

Overview

Stages

References