ACC/AHA Staging of Valvular Heart Disease

2. Aortic Stenosis (AS) Criteria

Symptoms

Asymptomatic Symptomatic (Angina, Syncope, Dyspnea)

Hemodynamic Severity (Echo)

At Risk (e.g., Bicuspid valve, Sclerosis) Progressive (Mild-Moderate AS; Vmax 2-3.9 m/s) Severe AS (Vmax ≥4.0 m/s OR AVA <1.0 cm²)

Modifiers (for Asymptomatic Severe AS)

LVEF < 50% Abnormal Exercise Test (Symptoms / BP drop) Very Severe AS (Vmax ≥5.0 m/s)

2. Aortic Regurgitation (AR) Criteria

Symptoms

Asymptomatic Symptomatic (Dyspnea, Angina, HF)

Severity & LV Size (Echo)

At Risk (e.g., Bicuspid valve, Aortic root dilation) Progressive (Mild-Moderate AR; Normal LV) Severe AR + Normal LVEF (≥50%) & Normal LV size Severe AR + LV Dilation (e.g., LVESD >50mm) Severe AR + Reduced LVEF (<50%)

2. Mitral Regurgitation (MR) Criteria

Etiology (Primary/Secondary)

Primary (Degenerative, Flail, etc.) Secondary (Functional, Ischemic)

Symptoms

Asymptomatic Symptomatic (Dyspnea, Fatigue, HF)

Severity & LV Status (Echo)

At Risk (e.g., MVP, Mild MR) Progressive (Moderate MR; Normal LV) Severe MR + Normal LVEF (>60%) & LVESD <40mm Severe MR + LV Dilation (LVESD ≥40mm) Severe MR + Reduced LVEF (≤60%)

2. Mitral Stenosis (MS) Criteria

Symptoms

Asymptomatic Symptomatic (Dyspnea, Fatigue, Hemoptysis)

Severity & Hemodynamics (Echo)

At Risk (Rheumatic fever hx, normal valve) Progressive (Mild-Moderate MS; MVA > 1.5 cm²) Severe MS (MVA ≤1.5 cm²)

Modifiers (for Asymptomatic Severe MS)

Pulmonary Hypertension (PASP > 50 mmHg) New-onset Atrial Fibrillation