ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -32 مورد

Stages of valvular aortic stenosis

Stages of valvular aortic stenosis
Stage Definition Valve anatomy Valve hemodynamics Hemodynamic consequences Symptoms
A At risk of AS
  • Bicuspid aortic valve (or other congenital valve anomaly)
  • Aortic valve sclerosis
  • Aortic Vmax <2 m/s
  • None
  • None
B Progressive AS
  • Mild to moderate leaflet calcification of a bicuspid or trileaflet valve with some reduction in systolic motion or
  • Rheumatic valve changes with commissural fusion
  • Mild AS: Aortic Vmax 2.0 to 2.9 m/s or mean ΔP <20 mmHg
  • Moderate AS: Aortic Vmax 3.0 to 3.9 m/s or mean ΔP 20 to 39 mmHg
  • Early LV diastolic dysfunction may be present
  • Normal LVEF
  • None
C: Asymptomatic severe AS
C1 Asymptomatic severe AS
  • Severe leaflet calcification or congenital stenosis with severely reduced leaflet opening
  • Aortic Vmax ≥4 m/s or mean ΔP ≥40 mmHg
  • AVA typically ≤1.0 cm2 (or AVAi ≤0.6 cm2/m2)
  • Very severe AS is an aortic Vmax ≥5 m/s or mean ΔP ≥60 mmHg
  • LV diastolic dysfunction
  • Mild LV hypertrophy
  • Normal LVEF
  • None: Exercise testing is reasonable to confirm symptom status
C2 Asymptomatic severe AS with LV dysfunction
  • Severe leaflet calcification or congenital stenosis with severely reduced leaflet opening
  • Aortic Vmax ≥4 m/s or mean ΔP ≥40 mmHg
  • AVA typically ≤1.0 cm2 (or AVAi ≤0.6 cm2/m2)
  • LVEF <50%
  • None
D: Symptomatic severe AS
D1 Symptomatic severe high-gradient AS
  • Severe leaflet calcification or congenital stenosis with severely reduced leaflet opening
  • Aortic Vmax ≥4 m/s or mean ΔP ≥40 mmHg
  • AVA typically ≤1.0 cm2 (or AVAi ≤0.6 cm2/m2) but may be larger with mixed AS/AR
  • LV diastolic dysfunction
  • LV hypertrophy
  • Pulmonary hypertension may be present
  • Exertional dyspnea or decreased exercise tolerance
  • Exertional angina
  • Exertional syncope or presyncope
D2 Symptomatic severe low-flow/low-gradient AS with reduced LVEF
  • Severe leaflet calcification with severely reduced leaflet motion
  • AVA ≤1.0 cm2 with resting aortic Vmax <4 m/s or mean ΔP <40 mmHg
  • Dobutamine stress echocardiography shows AVA ≤1.0 cm2 with Vmax ≥4 m/s at any flow rate
  • LV diastolic dysfunction
  • LV hypertrophy
  • LVEF <50%
  • HF
  • Angina
  • Syncope or presyncope
D3 Symptomatic severe low-gradient AS with normal LVEF or paradoxical low-flow severe AS
  • Severe leaflet calcification with severely reduced leaflet motion
  • AVA ≤1.0 cm2 with aortic Vmax <4 m/s or mean ΔP <40 mmHg
  • Indexed AVA ≤0.6 cm2/m2
  • Stroke volume index <35 mL/m2
  • Measured when patient is normotensive (systolic BP <140 mmHg)
  • Increased LV relative wall thickness
  • Small LV chamber with low stroke volume
  • Restrictive diastolic filling
  • LVEF ≥50%
  • HF
  • Angina
  • Syncope or presyncope
AR: aortic regurgitation; AS: aortic stenosis; AVA: aortic valve area; AVAi: aortic valve area indexed to body surface area; BP: blood pressure; ΔP: pressure gradient; HF: heart failure; LV: left ventricular; LVEF: left ventricular ejection fraction; Vmax: maximum aortic velocity.

Reproduced from: Nishimura RA, Otto CM, Bonow RO, et al. 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 2014; 63:e57. Table used with the permission of Elsevier Inc. All rights reserved.

Information still current as of 2021, as found in: Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e72.
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