Aortic stenosis stages
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 | ❑ Severe leaflet 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 ❑ LVH ❑ May present with pulmonary hypertension |
❑ 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 or congenital stenosis with severely reduced opening | ❑ 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 ❑ LVH ❑ LVEF <50% |
❑ HF ❑ Angina ❑ Syncope or presyncope |
| D3 | Sympomatic severe low gradient | ❑ Severe leaflet calcification with severely reduced opening | ❑ 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% |
❑ HF ❑ Angina ❑ Syncope or presyncope |