15
Valve Hemodynamics
Hemodynamic
Consequences Symptoms
AR severity: none or trace None None
Mild AR:
• Jet width <25% of left ventricular
outflow tract (LVOT);
• Vena contracta <0.3 cm;
• RVol <30 mL/beat;
• RF <30%;
• Effective regurgitant orifice (ERO)
<0.10 cm
2
;
• Angiography grade 1+
Moderate AR:
• Jet width 25%–64% of LVOT;
• Vena contracta 0.3–0.6 cm;
• RVol 30–59 mL/beat;
• RF 30%–49%;
• ERO 0.10–0.29 cm
2
;
• Angiography grade 2+
• Normal LV systolic
function
• Normal LV volume or
mild LV dilation
None
Severe AR:
• Jet width ≥65% of LVOT;
• Vena contracta >0.6 cm;
• Holodiastolic flow reversal in the
proximal abdominal aorta;
• RVol ≥60 mL/beat;
• RF ≥50%;
• ERO ≥0.3 cm
2
;
• Angiography grade 3+–4+;
• In addition, diagnosis of chronic
severe AR requires evidence of LV
dilation
C1:
• Normal LVEF (≥50%)
and mild-to-moderate
LV dilation (LVESD
≤50 mm)
C2:
• Abnormal LV systolic
function with depressed
LVEF (<50%) or severe
LV dilatation (LVESD
>50 mm or indexed
LVESD >25 mm/m
2
)
None; exercise
testing is
reasonable to
confirm symptom
status
Severe AR:
• Doppler jet width ≥65% of LVOT;
• Vena contracta >0.6 cm;
• Holodiastolic flow reversal in the
proximal abdominal aorta;
• RVol ≥60 mL/beat;
• RF ≥50%;
• ERO ≥0.3 cm
2
;
• Angiography grade 3+–4+;
• In addition, diagnosis of chronic
severe AR requires evidence of
LV dilation
• Symptomatic severe
AR may occur with
normal systolic function
(LVEF ≥50%), mild-to-
moderate LV dysfunction
(LVEF 40%–50%), or
severe LV dysfunction
(LVEF <40%)
• Moderate-to-severe LV
dilation
• Exertional
dyspnea or
angina or more
severe HF
symptoms
