16
Aortic Regurgitation
Table 12. Diagnosis, Medical Therapy, and Intervention in
Patients With Chronic AR
Recommendations
COR LOE
TTE is indicated in patients with signs or symptoms of
AR (stages A-D) for accurate diagnosis of the cause of
regurgitation, regurgitant severity, and LV size and systolic
function, and for determining clinical outcome and timing
of valve intervention.
I B
TTE is indicated in patients with dilated aortic sinuses or
ascending aorta or with a bicuspid aortic valve (stages A
and B) to evaluate the presence and severity of AR.
I B
CMR is indicated in patients with moderate or severe AR
(stages B-D) and suboptimal echocardiographic images for
the assessment of LV systolic function, systolic and diastolic
volumes, and measurement of AR severity.
I B
Medical erapy
Treatment of hypertension (systolic BP >140 mm Hg )
is recommended in patients with chronic AR (stages B
and C), preferably with dihydropyridine calcium channel
blockers or ACE inhibitors/ARBs.
I B
Medical therapy with ACE inhibitors/ARBs and beta
blockers is reasonable in patients with severe AR who have
symptoms and/or LV dysfunction (stages C2 and D) when
surgery is not performed because of comorbidities.
IIa B
Surgical Intervention
AVR is indicated for symptomatic patients with severe AR
regardless of LV systolic function (stage D).
I B
AVR is indicated for asymptomatic patients with chronic severe
AR and LV systolic dysfunction (LVEF <50%) at rest (stage
C2) if no other cause for systolic dysfunction is identified.
I B
AVR is indicated for patients with severe AR (stage C or
D) while undergoing cardiac surgery for other indications.
I C
AVR is reasonable for asymptomatic patients with severe
AR with normal LV systolic function (LVEF ≥50%) but
with severe LV dilation (LVESD >50 mm or indexed
LVESD >25 mm/m
2
) (stage C2).
IIa B
AVR is reasonable in patients with moderate AR (stage B)
while undergoing surgery on the ascending aorta, CABG,
or mitral valve (MV) surgery.
IIa C
AVR may be considered for asymptomatic patients with
severe AR and normal LV systolic function at rest (LVEF
≥50%, stage C1) but with progressive severe LV dilation
(le ventricular end-diastolic dimension [LVEDD] >65 mm)
if surgical risk is low.
IIb C
