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2017 Update Incorporated - Valvular Heart Disease

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7 Valve Hemodynamics Hemodynamic Consequences Symptoms Aortic V max <2 m/s None None • Mild AS: Aortic V max 2.0–2.9 m/s or ∆Pmean <20 mm Hg • Moderate AS: Aortic V max 3.0–3.9 m/s or ∆Pmean 20–39 mm Hg • Early LV diastolic dysfunction may be present • Normal left ventricular ejection fraction (LVEF) None • Aortic V max ≥4 m/s or ∆Pmean ≥40 mm Hg • Aortic valve area (AVA) typically ≤1.0 cm 2 (or AVAi ≤0.6 cm 2 /m 2 ) • Very severe AS: Aortic V max ≥5 m/s or ∆Pmean ≥60 mm Hg • LV diastolic dysfunction • Mild LV hypertrophy • Normal LVEF None: Exercise testing is reasonable to confirm symptom status • Aortic V max ≥4 m/s or ∆Pmean ≥40 mm Hg • AVA typically ≤1.0 cm 2 (or AVAi ≤0.6 cm 2 /m 2 ) LVEF <50% None • Aortic V max ≥4 m/s or ∆Pmean ≥40 mm Hg • AVA typically ≤1.0 cm 2 (or AVAi ≤0.6 cm 2 /m 2 ) but may be larger with mixed AS/AR • LV diastolic dysfunction • LV hypertrophy • Pulmonary hypertension (PHTN) may be present • Exertional dyspnea or decreased exercise tolerance • Exertional angina • Exertional syncope or presyncope • AVA ≤1.0 cm 2 with resting aortic V max <4 m/s or ∆Pmean <40 mm Hg • Dobutamine stress echocardiography (DSE) shows AVA ≤1.0 cm 2 with V max ≥4 m/s at any flow rate • LV diastolic dysfunction • LV hypertrophy • LVEF <50% • Heart failure (HF) • Angina • Syncope or presyncope • AVA ≤1.0 cm 2 with aortic V max <4 m/s or ∆Pmean <40 mm Hg • Indexed AVA ≤0.6 cm 2 /m 2 and • Stroke volume index <35 mL/m 2 • Measured when patient is normotensive (systolic blood pressure [BP] <140 mm Hg ) • Increased LV relative wall thickness • Small LV chamber with low stroke volume • Restrictive diastolic filling • LVEF ≥50% • HF • Angina • Syncope or presyncope

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