Qualitative
Aortic valve morphology
Colour flow AR jet widtha
CW signal of AR jet
Diastolic flow reversal in descending aorta
Semi-quantitative
VC width (mm)
Pressure half-time (ms)b
Quantitative
EROA (mm2)
R Vol (mL)
LV size
| Aortic valve morphology |
| Mild |
| Normal/Abnormal |
| Moderate |
| Normal/Abnormal |
| Severe |
| Abnormal/flail/large coaptation defect |
| Colour flow AR jet widtha |
| Mild |
| Small in central jets |
| Moderate |
| Intermediate |
| Severe |
| Large in central jet, variable in eccentric jets |
| CW signal of AR jet |
| Mild |
| Incomplete/faint |
| Moderate |
| Dense |
| Severe |
| Dense |
| Diastolic flow reversal in descending aorta |
| Mild |
| Brief, protodiastolic flow reversal |
| Moderate |
| Intermediate |
| Severe |
| Holodiastolic flow reversal (end-diastolic velocity >20 cm/s) |
| VC width (mm) |
| Mild |
| <3 |
| Moderate |
| Intermediate |
| Severe |
| >6 |
| Pressure half-time (ms)b |
| Mild |
| >500 |
| Moderate |
| Intermediate |
| Severe |
| <200 |
| EROA (mm2) |
| Mild |
| <10 |
| Moderate |
| 10–19; 20–29c |
| Severe |
| ≥30 |
| R Vol (mL) |
| Mild |
| <30 |
| Moderate |
| 30–44; 45–59c |
| Severe |
| ≥60 |
| LV size |
| Unless for other reasons, the LV size is usually normal in patients with mild AR. In acute severe AR, the LV size is often normal. In chronic severe AR, the LV is classically dilated. Accepted cut-off values for non-significant LV enlargement: LV end-diastolic diameter <56 mm, LV end-diastolic volume <82 mL/m2, LV end-systolic diameter <40 mm, LV end-systolic volume <30 mL/m2. |
AR = aortic regurgitation; CW = continuous-wave; LA = left atrium; EROA = effective regurgitant orifice area; LV = left ventricle; R Vol = regurgitant volume; VC = vena contracta.
aAt a Nyquist limit of 50–60 cm/s. - bPHT is shortened with increasing LV diastolic pressure, vasodilator therapy, and in patients with a dilated compliant aorta or lengthened in chronic AR.
cGrading of the severity of AR classifies regurgitation as mild, moderate or severe and subclassifies the moderate regurgitation group into ‘mild-to-moderate’ (EROA of 10–19 mm or an R Vol of 30–44 mL) and ‘moderateto-severe’ (EROA of 20–29 mm2 or an R Vol of 45–59 mL).