2023 Korean Society of Echocardiography position paper for diagnosis and management of valvular heart disease, part I: aortic valve disease

Table 1 Stages of aortic stenosis

Characteristic	Stage
	A	B		C1	C2	D1	D2	D3
Definition	At risk	Progressive		Asymptomatic severe		Symptomatic severe
Severity	Normal to trivial	Mild	Moderate	Severe
Echocardiography
Morphology
Leaflet	BAV, sclerosis	Calcified, fibro-thickening, commissure fusion		Severe calcified, fibro-thickening, commissure fusion
Motion	Normal	Mild to moderate systolic motion reduction		Severely reduced opening
AVA-CE (cm²)	-	1.5–2.0	1.0–1.5	≤1.0	≤1.0	≤1.0	≤1.0^a	≤1.0
Vmax (m/sec)	<2.0	2.0–2.9	3.0–3.9	≥4.0	≥4.0	≥4.0	<4.0^a	<4.0
MSPG (mmHg)	-	<20	20–39	≥40	≥40	≥40	<40	<40
AVAi (cm²)	-	≥1.0	0.6–0.9	<0.6
LV diastolic dysfunction	None	Early		Mild		Significant		Restrictive
LV hypertrophy	None	Mild		Mild		Significant		↑RWT, ↓Cavity
LVEF	Normal	Normal		Normal	<50	Normal	<50	Normal^b
Flow-gradient	Normal	Normal		NF-HG	NF-HG	NF-HG	LF-LG	NF-LG/pLF-LG
Symptom	None	None		None		DOE, EI, cardinal symptoms^c

BAV Bicuspid aortic valve, AVA-CE Aortic valve area by continuity equation, Vmax Peak aortic jet velocity, MSPG Mean systolic pressure gradient, AVAi Aortic valve area index, LV Left ventricular, RWT Relative wall thickness, LVEF Left ventricular ejection fraction, NF Normal flow, HG High gradient, LF Low flow, LG Low gradient, pLF paradoxical low flow, DOE Dyspnea on exertion, EI Exercise intolerance
^aAVA < 1.0 cm² with AV Vmax > 4.0 m/sec during dobutamine stress echocardiography in D2
^bStroke volume index < 35 mL/m²
^cCardinal symptoms include heart failure, angina, presyncope, and syncope

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