Table 5.
Asymptomatic severe AS patients at high risk.36
| Risk factor | High risk value | Guideline recommendation for AVR |
|---|---|---|
| Valve assessment | ||
| Peak jet velocity | >5 m/s | AHA IIb |
| AV area | <0.6 cm2 | AHA IIb |
| Rate of progression of jet velocity | >0.3 m/s/year | ESC IIa (moderate–severe AS) |
| Degree of valve calcification | Dense – all cusps | |
| Valvulo arterial impedance | >4.5–4.9 mmHg/mm/m2 | |
| LV assessment | ||
| LV systolic dysfunction | EF < 50% | ESC I and AHA I |
| LVH | >15 mm without high BP | ESC IIb |
| LV mass | >110% expected for body size and gender | |
| Strain | Global longitudinal strain <15.9% | |
| Indexed LA area | >12.2 cm2/m2 | |
| Stress test | ||
| TMT | Symptoms | ESC I and AHA IIb |
| Fall in BP | ESC IIa and AHA IIb | |
| Complex arrhythmias | ESC IIb | |
| Exercise echo | Mean pressure increase by 18–20 mmHg | |