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
