p.34 抽出テキスト

Otto et al 2020 ACC/AHA Guideline for the Management of Valvular Heart Disease

Circulation. 2021;143:e72–e227. DOI: 10.1161/CIR.0000000000000923 February 2, 2021 e105 CLINICAL STATEMENTS AND GUIDELINES

Table 15.  Stages of Chronic AR

Stage Definition Valve Anatomy Valve Hemodynamics Hemodynamic Consequences Symptoms A At risk of AR BAV (or other congenital valve anomaly)

Aortic valve sclerosis Diseases of the aortic sinuses or ascending aorta History of rheumatic fever or known rheumatic heart disease IE AR severity: none or trace None None

B Progressive AR Mild to moderate calcification of a trileaflet valve BAV (or other congenital valve anomaly)

Dilated aortic sinuses Rheumatic valve changes Previous IE Mild AR:

Jet width <25% of LVOT Vena contracta <0.3 cm Regurgitant volume <30 mL/

beat Regurgitant fraction <30% ERO <0.10 cm2 Angiography grade 1 Moderate AR: Jet width 25%–64% of LVOT Vena contracta 0.3–0.6 cm Regurgitant volume 30–59 mL/

beat Regurgitant fraction 30% to

49% ERO 0.10–0.29 cm2 Angiography grade 2 Normal LV systolic function

Normal LV volume or mild LV dilation None

C Asymptomatic severe AR Calcific aortic valve disease

Bicuspid valve (or other congenital abnormality) Dilated aortic sinuses or ascending aorta Rheumatic valve changes IE with abnormal leaflet closure or perforation Severe AR:

Jet width ≥65% of LVOT Vena contracta >0.6 cm Holodiastolic flow reversal in

the proximal abdominal aorta Regurgitant volume ≥60 mL/

beat Regurgitant fraction ≥50% ERO ≥0.3 cm2 Angiography grade 3 to 4 In addition, diagnosis of chronic

severe AR requires evidence of LV dilation C1: Normal LVEF (>55%) and mild to moderate LV dilation (LVESD <50 mm)

C2: Abnormal LV systolic function with depressed LVEF (≤55%) or severe LV dilation (LVESD >50 mm or indexed LVESD >25 mm/m2) None; exercise testing is reasonable to confirm symptom status

D Symptomatic severe AR Calcific valve disease

Bicuspid valve (or other congenital abnormality) Dilated aortic sinuses or ascending aorta Rheumatic valve changes Previous IE with abnormal leaflet closure or perforation Severe AR:

Doppler jet width ≥65% of

LVOT Vena contracta >0.6 cm Holodiastolic flow reversal in

the proximal abdominal aorta Regurgitant volume ≥60 mL/

beat Regurgitant fraction ≥50% ERO ≥0.3 cm2 Angiography grade 3 to 4 In addition, diagnosis of chronic

severe AR requires evidence of LV dilation Symptomatic severe AR may occur with normal systolic function (LVEF >55%), mild to moderate LV dysfunction (LVEF 40% to 55%), or severe LV dysfunction (LVEF <40%)

Moderate to severe LV dilation is present Exertional dyspnea or angina or more severe HF symptoms

AR indicates aortic regurgitation; BAV, bicuspid aortic valve; ERO, effective regurgitant orifice; HF, heart failure; IE, infective endocarditis; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; and LVOT, left ventricular outflow tract.

Downloaded from http://ahajournals.org by on October 7, 2026