Signs
Specific signs for AR severity
Mild:
  • Central Jet, width <25% of LVOT
  • Vena contracta <0.3 cm(2)
  • No or brief early diastolic flow reversal in descending aorta
Moderate:
  • Signs of AR>mild present but no criteria for severe AR
Severe:
  • Central Jet, width ≥65% of LVOT
  • Vena contracta >0.6 cm(2)
Supportive signs
Mild:
  • Pressure half-time >500 ms
  • Normal LV size(1)
Moderate:
  • Intermediate values
Severe:
  • Pressure half-time <200 ms
  • Holodiastolic aortic flow reversal in descending aorta
  • Moderate or greater LV enlargement(3)
Quantitative parameters(4)
R Vol (mL/beat)
Mild:<30
Mild-Moderate:30-44
Moderate-Severe:45-59
Severe:≥60
RF (%)
Mild:<30
Mild-Moderate:30-39
Moderate-Severe:40-49
Severe:≥50
EROA (cm2)
Mild:<0.10
Mild-Moderate:0.10-0.19
Moderate-Severe:0.20-0.29
Severe:≥0.30

AR, Aortic regurgitation; EROA, effective regurgitant orifice area; LV, left ventricle; LVOT, left ventricular outflow tract; R Vol, regurgitant volume; RF, regurgitant fraction.

  1. LV size applied only to chronic lesions. Normal 2D measurements: LV minor-axis ≤2.8 cm/m2, LV end-diastolic volume ≤82 mL/m2 (2).
  2. At a Nyquist limit of 50–60 cm/s.
  3. In the absence of other etiologies of LV dilatation.
  4. Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.

Based on data in the literature and a consensus of the committee members, the Task Force proposes a scheme of specific signs (≥90% specificity), along with supportive signs whose predictive accuracy is more modest, and quantitative parameters for AR severity (Table 2). In applying this scheme, it is the consensus of the committee members that the process of grading AR should be comprehensive using a combination of these signs, clues and measurements obtained by Doppler-echocardiography.