Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Aortic stenosis stages
Introduction
Overview
Overview
Aortic stenosis can be classified into 7 stages based on the valve’s anatomy and hemodynamics as well as the patients symptoms.
Stages
Stages
Shown below is a table summarizing the stages of aortic stenosis (AS) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease.[1]
Abbreviations: AR: Aortic regurgitation; AS: Aortic stenosis; AVA: Aortic valve area; LV: Left ventricle; LVEF: Left ventricular ejection fraction
| STAGE | DEFINITION | SYMPTOMS | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES |
|---|---|---|---|---|---|
| A | At risk of AS | • None | • Bicuspid valve • Valve sclerosis |
• Vmax < 2 m/s | • None |
| B | Progressive AS | • None | • Mild-to-moderate calcification • Rheumatic valve changes with commissural fusion |
• Mild AS: Vmax = 2.0-2.9 m/s or mean ΔP < 20 mmHg • Moderate AS: Vmax = 3.0-3.9 m/s or mean ΔP 20-39 mmHg |
• Early LV diastolic dysfunction may be present • Normal LVEF |
| C1 | Asymptomatic severe AS | • None • Exercise testing to confirm symptom status |
• Severe 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 left ventricular hypertrophy • Normal LVEF |
| C2 | Asymptomatic severe AS with LV dysfunction | • None | • Severe calcification or congenital stenosis with severely reduced opening | • Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg • AVA ≤ 1.0 cm² |
• LVEF < 50% |
| D1 | Symptomatic severe high-gradient AS | • Exertional dyspnea or decreased exercise tolerance • Exertional angina • Exertional syncope or presyncope |
• Severe 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 • Left ventricular hypertrophy • May present with pulmonary hypertension |
| D2 | Symptomatic severe low-flow/low gradient AS with reduced LVEF | • Heart failure • Angina • Syncope or presyncope |
• Severe calcification or congenital stenosis with severely reduced leaflet motion | • AVA ≤ 1.0 cm² with resting aortic Vmax < 4 m/s or mean ΔP ≥ 40 mmHg • Dobutamine stress echo shows AVA ≤ 1.0 cm² with Vmax ≥ 4 m/s at any flow rate |
• LV diastolic dysfunction • Left ventricular hypertrophy • LVEF <50% |
| D3 | Symptomatic severe low gradient with normal LVEF | • Heart failure • Angina • Syncope or presyncope |
• Severe calcification with severely reduced leaflet motion | • AVA ≤ 1.0 cm² with Vmax < 4 m/s or mean ΔP ≤ 40 mmHg • AVA ≤ 0.6 cm² • Stroke volume index < 35 mL/m² |
• Increased LV relative wall thickness • Small LV chamber with low stroke volume • Restrictive diastolic filling • LVEF ≥ 50% |
References
References
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Usama Talib, BSc, MD [3]