Echocardiographic criteria for the definition of severe valve stenosis and regurgitation are addressed in specific documents.2–4 Recommendations for stenotic lesions are indicated in the corresponding sections and quantification of regurgitant lesions is summarized in Table 4. An integrated approach including various criteria is strongly recommended instead of referring to single measurements. Echocardiography is also key to assess valve morphology and function as well as to evaluate the feasibility and indications of a specific intervention.
Echocardiographic criteria for the definition of severe valve regurgitation: an integrative approach (adapted from Lancellotti et al.2,6,7)
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CW = continuous wave; EDV = end-diastolic velocity; EROA = effective regurgitant orifice area; LA = left atrium/atrial; LV = left ventricle/ventricular; PISA = proximal isovelocity surface area; RA = right atrium/right atrial; RV = right ventricle; TR = tricuspid regurgitation; TVI = time–velocity integral.
At a Nyquist limit of 50–60 cm/s.
For average between apical four- and two-chamber views.
Unless other reasons for systolic blunting (atrial fibrillation, elevated atrial pressure).
In the absence of other causes of elevated LA pressure and of mitral stenosis.
In the absence of other causes of elevated RA pressure.
Pressure half-time is shortened with increasing LV diastolic pressure, vasodilator therapy, and in patients with a dilated compliant aorta, or lengthened in chronic aortic regurgitation.
Baseline Nyquist limit shift of 28 cm/s.
Different thresholds are used in secondary mitral regurgitation where an EROA >20 mm2 and regurgitant volume >30 mL identify a subset of patients at increased risk of cardiac events.
Echocardiographic criteria for the definition of severe valve regurgitation: an integrative approach (adapted from Lancellotti et al.2,6,7)
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CW = continuous wave; EDV = end-diastolic velocity; EROA = effective regurgitant orifice area; LA = left atrium/atrial; LV = left ventricle/ventricular; PISA = proximal isovelocity surface area; RA = right atrium/right atrial; RV = right ventricle; TR = tricuspid regurgitation; TVI = time–velocity integral.
At a Nyquist limit of 50–60 cm/s.
For average between apical four- and two-chamber views.
Unless other reasons for systolic blunting (atrial fibrillation, elevated atrial pressure).
In the absence of other causes of elevated LA pressure and of mitral stenosis.
In the absence of other causes of elevated RA pressure.
Pressure half-time is shortened with increasing LV diastolic pressure, vasodilator therapy, and in patients with a dilated compliant aorta, or lengthened in chronic aortic regurgitation.
Baseline Nyquist limit shift of 28 cm/s.
Different thresholds are used in secondary mitral regurgitation where an EROA >20 mm2 and regurgitant volume >30 mL identify a subset of patients at increased risk of cardiac events.
