Aortic Regurgitation

Color Doppler: Jet Width & Vena Contracta

  • Jet Width / LVOT Diameter Ratio
    • Mild: <25%
    • Moderate: 25–64%
    • Severe: ≥65%
  • Vena Contracta Width
    • Mild: <0.3 cm
    • Moderate: 0.3–0.6 cm
    • Severe: >0.6 cm

Pressure Half-Time (PHT)

  • Measures rate of pressure equalization between LV & aorta.
    • Mild: >500 ms
    • Moderate: 200–500 ms
    • Severe: <200 ms

Holodiastolic Flow Reversal (Descending Aorta)

PW Doppler in descending aorta

  • Absent or brief: Mild
  • Holodiastolic reversal: Severe

Regurgitant Volume & Fraction 

  • Regurgitant Volume (RVol)
    • Mild: <30 mL
    • Moderate: 30–59 mL
    • Severe: ≥60 mL
  • Regurgitant Fraction (RF)
    • Mild: <30%
    • Moderate: 30–49%
    • Severe: ≥50%

LV Size & Function

  • Chronic severe AR → LV dilation (LVEDD >65 mm, LVESD >50 mm).
  • EF typically preserved until late; declining EF suggests decompensation.

Severe AR usually shows

  • Wide jet (>65% LVOT)
  • Vena contracta >0.6 cm
  • PHT <200 ms
  • Holodiastolic flow reversal
  • RVol ≥60 mL or RF ≥50%
  • LV dilation +/- decreased EF

References

  1. Zoghbi, W. A., Adams, D., Bonow, R. O., Enriquez-Sarano, M., Foster, E., Grayburn, P. A., Hahn, R. T., Han, Y., Hung, J., Lang, R. M., Little, S. H., Shah, D. J., Shernan, S., Thavendiranathan, P., Thomas, J. D., & Weissman, N. J. (2017). Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 30(4), 303–371. https://doi.org/10.1016/j.echo.2017.01.007
  2. Lancellotti, P., Tribouilloy, C., Hagendorff, A., Moura, L., Popescu, B. A., Agricola, E., Monin, J. L., Pierard, L. A., Badano, L., & Zamorano, J. L. (2013). Recommendations for the echocardiographic assessment of native valvular regurgitation: An executive summary from the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging, 14(7), 611–644. https://doi.org/10.1093/ehjci/jet105
  3. Otto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., III, Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., O’Gara, P. T., Rigolin, V. H., Sundt, T. M., III, & Thompson, A. (2021). 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Circulation, 143(5), e72–e227. https://doi.org/10.1161/CIR.0000000000000923
  4. Praz, F., Borger, M. A., Lanz, J., Marin-Cuartas, M., Abreu, A., Adamo, M., Ajmone Marsan, N., Barili, F., Bonaros, N., Cosyns, B., De Paulis, R., Gamra, H., Jahangiri, M., Jeppsson, A., Klautz, R. J. M., Mores, B., Pérez-David, E., Pöss, J., Prendergast, B. D., ... Wojakowski, W. (2025). 2025 ESC/EACTS guidelines for the management of valvular heart disease. European Heart Journal, 46(44), 4635–4736. https://doi.org/10.1093/eurheartj/ehaf194
  5. Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C., Jr., Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O’Gara, P. T., O’Rourke, R. A., Otto, C. M., Shah, P. M., & Shanewise, J. S. (2008). 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. Circulation, 118(15), e523–e661. https://doi.org/10.1161/CIRCULATIONAHA.108.190748