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Understanding the special considerations needed during work-up and imaging is crucial to determine timing of intervention for your symptomatic severe aortic stenosis patients

Click each stage to better understand the ACC/AHA hemodynamic parameters on determining which patients need timely intervention for their AS.

Hemodynamic parameters for symptomatic severe AS defined by ACC/AHA Guideline1

Select a stage to see the related data:

Definition

Symptomatic severe high gradient AS

Valve hemodynamics

Aortic valve areas:
Typically AVA ≤ 1.0 cm2
(or AVAi ≤ 0.6 cm2/m2)
Aortic Vmax:
≥ 4 m/s
or
Mean pressure gradient:
≥ 40 mm Hg

Hemodynamic consequences

  • LV diastolic dysfunction
  • LV hypertrophy
  • Pulmonary hypertension may be present

Definition

Symptomatic severe AS low-flow/low-gradient with reduced LVEF

Valve hemodynamics

Aortic valve areas:
AVA ≤ 1.0 cm2
Aortic Vmax:
< 4 m/s
or
Mean pressure gradient:
< 40 mm Hg

Hemodynamic consequences

  • LV diastolic dysfunction
  • LV hypertrophy
  • LVEF < 50%

Definition

Symptomatic severe low-gradient with normal LVEF or paradoxical low-flow

Valve hemodynamics

Aortic valve areas:
AVA ≤ 1.0 cm2
(AVAi ≤ 0.6 cm2/m2)
and stroke volume index < 35 ml/m2 measured when patient is normotensive*
Aortic Vmax:
< 4 m/s
or
Mean pressure gradient:
< 40 mm Hg

*Systolic blood pressure < 140 mm Hg.

Hemodynamic consequences

  • Increased LV relative wall thickness
  • Small LV chamber with low stroke volume
  • Restrictive diastolic filling
  • LVEF ≥ 50%

Echocardiography Reference Guide for SAS

See the latest ACC/AHA aortic valve replacement indications. This one-page guide with echo parameters may aid your diagnosis and treatment of patients with or at risk for severe aortic stenosis.

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