Types of Severe Aortic Stenosis
Severe AS type | Vmax | Valve area | LV EF | Other |
|---|---|---|---|---|
High gradient (asymptomatic or symptomatic) | ≥ 4.0 m/second | ≤ 1.0 cm2 | ≥ 50% | — |
Low-flow, low-gradient with reduced EF | < 4.0 m/second | ≤ 1.0 cm2 | < 50% | Distinguish from pseudo-stenosis with low-dose dobutamine echocardiography, valve area < 1.0 cm2, Vmax > 4.0 m/second |
Low-flow, low-gradient with normal EF (paradoxical low-flow AS) | < 4.0 m/second | ≤ 1.0 cm2 | ≥ 50% with small hypertrophied LV | Distinguish from non-severe AS by stroke volume index < 35 mL/m2 measured when patient is normotensive |
AS = aortic stenosis; DVI = Doppler velocity index, the ratio of LV outflow tract to aortic velocity; LV EF = left ventricular ejection fraction; Vmax = peak forward velocity across the aortic valve. | ||||
Data from Otto CM, Nishimura RA, Bonow RO, et al: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 143(5):e35–e71, 2021. doi: 10.1161/CIR.0000000000000932 | ||||