Aortic stenosis stages

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Stages

STAGE	DEFINITION	VALVE ANATOMY	VALVE HEMODYNAMICS	HEMODYNAMIC CONSEQUENCES	SYMPTOMS
A	At risk of AS	❑ Bicuspid valve ❑ Valve sclerosis	Vmax < 2 m/s	❑ None	❑ None
B	Progressive AS	❑ Mild-to-moderate leaflet calcification of valve ❑ 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	❑ None
C1	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
C2	Asymptomatic severe AS with LV dysfunction	❑ Severe leaflet calcification or congenital stenosis with severely reduced opening	❑ Vmax ≥ 4 m/s or mean ΔP ≥ 40 mmHg ❑ AVA ≤ 1.0 cm²	❑ LVEF < 50%	❑ None
D1	Symptomatic severe high-gradient AS
D2	Symptomatic severe low-flow/low gradient AS with reduced LVEF
D3	Sympromatic severe low gradient