Aortic regurgitation
Echocardiographic assessment of aortic regurgitation grade
Parameters
mild AR
moderate AR
severe AR
Structural parameters
Aortic leaflets
Normal or abnormal
Normal or abnormal
Abnormal/flail, or wide coaptation defect
LV size
Normal*
Normal or dilated
Usually dilated†
Qualitative Doppler
Jet width in LVOT, color flow
Small in central jets
Intermediate
Large in central jets; variable in eccentric jets
Flow convergence, color flow
None or very small
Intermediate
Large
Jet density, CW
Incomplete or faint
Dense
Dense
Jet deceleration rate, CW (PHT, msec)‡
Slow, >500
Medium, 500-200
Steep, <200
Diastolic flow reversal in descending aorta, PW
Brief, early diastolic reversal
Intermediate
Prominent holodiastolic reversal
Semiquantitative parameters§
VCW (cm)
<0.3
0.3-0.6
>0.6
Jet width/LVOT width, central jets (%)
<25
25-45 46-64
≥65
Jet CSA/LVOT CSA, central jets (%)
<5
5-20 21-59
≥60
Quantitative parameters§
RVol (mL/beat)
<30
30-44 45-59
≥60
RF (%)
<30
30-39 40-49
≥50
EROA (cm²)
<0.10
0.10-0.19 0.20-0.29
≥0.30
PHT, Pressure half-time; PW, pulsed wave Doppler. Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler is usually performed at a Nyquist limit of 50-70 cm/sec.
*Unless there are other reasons for LV dilation.
† Specific in normal LV function, in the absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
‡ PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
§ Quantitative parameters can subclassify the moderate regurgitation group.
References
1) Zoghbi, W.A., Adams, D., Bonow, R.O., Enriquez-Sarano, M., Foster, E., Grayburn, P.A., Hahn, R.T., Han, Y., Hung, J.W., Lang, R.M., Little, S.H., Shah, D.J., Shernan, S.K., Thavendiranathan, P., Thomas, J., & Weissman, N. (2017). Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 30 4, 303-371 .