Stage | Description and symptoms | Valve anatomy | Hemodynamics | LVEF | ||
Ca++ | Mobility | Key criteria | Additional measures | |||
A | At risk (asymptomatic) | + | Normal | Aortic Vmax <2 m/s | – | Normal |
B | Progressive (asymptomatic) | ++ | ↓ to ↓↓ | Mild AS: Aortic Vmax 2.0 to 2.9 m/s or mean ΔP <20 mmHg Moderate AS: Aortic Vmax 3.0 to 3.9 m/s or mean ΔP 20 to 39 mmHg | – | Normal |
C1 | Asymptomatic severe AS with normal LVEF | +++ | ↓↓↓ | Aortic Vmax ≥4 m/s or mean ΔP 40 mmHg (severe) | AVA typically ≤1 cm2 (or AVAi ≤0.6 cm2/m2) | Normal |
C2 | Asymptomatic severe AS with low LVEF | +++ | ↓↓↓ | Aortic Vmax ≥4 m/s or mean ΔP ≥40 mmHg (severe) | AVA typically ≤1 cm2 (or AVAi ≤0.6 cm2/m2) | <50% |
D1 | Symptomatic severe high-gradient AS | ++++ | ↓↓↓↓ | Aortic Vmax ≥4 m/s or mean ΔP ≥40 mmHg | AVA typically ≤1 cm2 (or AVAi ≤0.6 cm2/m2) but may be larger with mixed AS/AR | Normal or ↓ |
D2 | Symptomatic severe low-gradient AS with low LVEF | ++++ | ↓↓↓↓ | Resting AVA ≤1 cm2 with aortic Vmax <4 m/s or mean ΔP <40 mmHg | Dobutamine stress shows AVA ≤1 cm2 with Vmax ≥4 m/s at any flow rate | <50% |
D3 | Symptomatic severe low-gradient AS with normal LVEF | ++++ | ↓↓↓↓ | AVA ≤1 cm2 with aortic Vmax <4 m/s or mean ΔP <40 mmHg Measured when the patient is normotensive (systolic BP <140 mmHg) | Indexed AVA ≤0.6 cm2/m2 and stroke volume index <35 mL/m2 | Normal |
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