Parameters of Aortic Regurgitation on Echocardiography

  • Aortic Regurgitation

    Mild
    Moderate
    Severe
    Structural parameters
    Aortic leaflets Normal or abnormal Normal or abnormal Abnormal/flail, or wide coaptation defect
    Left ventricle (Size) Normal1

    (LVEDV =150ml male, =106ml female)

    		 Normal or mild dilated Usually dilated2

    (LVEDV >150ml male, >106ml female)
    Qualitative doppler
    RegJetwidht

    Regurgitation jet witdh

    		 Small in central jets

    (Width in LVOT <25%)

    		 Intermediate Large in central jets; variable in eccentric jets

    (Width in LVOT >65%)
    Flow convergence (PISAr) None or very small

    (<0,3cm)

    		 Intermediate Large

    (=1cm)
    RegJetdensity

    Regurgitant jet density
    (CW doppler)

    		 Incomplete or faint Dense Dense
    PHTRegJet3

    Pressure half time of regurgitant jet

    		 Incomplete or faint Slow

    (>500ms)

    		 Medium

    (200-500ms)

    		 Steep

    <200ms
    Diastolic reversal flow

    in descending aorta (PW doppler)

    		 Brief, early diastolic reversal Intermediate Prominent holodiastolic reversal
    Semiquantitative parameters4
    VCW (cm)

    Vena contracta width

    		 <0,3 0,3 - 0,6 >0,6
    RegJetwidth in LVOT (%)

    Regurgitation jet width in LVOT (centrel jets)

    		 <25 25-45 46-64 >65
    CSARegJet in CSA LVOT (%)

    Regurgitation jet CSA in LVOT CSA (centrel jets)

    		 <5 5-20 21-59 >60
    Quantitative parameters4
    Grade I Grade II Grade III Grade IV
    EROA (cm2)

    Effective regurgitant orifice area

    		 <0,1 0,1 - 0,19 0,2 - 0,29 >0,3
    RegVol (ml)

    Regurgitant volume of aortic regurgitation

    		 <30 30 - 44 45 - 59 >60
    RF (%)

    Regurgitant fraction of aortic valve

    		 <30 30 - 39 40 - 49 >50

    Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

    (1) Unless there are other reasons for LV dilation. (2) Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate. (3) PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR. (4) Quantitative parameters can subclassify the moderate regurgitation group.

    ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)