Echocardiography (Aortic valve)

Vmax AR (Peak aortic regurgitation velocity)

EROA = 2π x PISAr² x Va / Vmax AR

Effective regurgitant orifice area

Is the narrowest area of aortic regurgitation flow.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Echocardiography: Aortic regurgitation quantification (Algorithm)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

PISAr

Proximal isovelocity surface area radius

The radius of PISA is measured from the surface of the hemisphere to the narrowest portion of jet (Vena contracta).

Vena contracta is narrowest portion of jet as emerges from aortic orifice.
The flow convergence zone is the zone of increased flow velocity before the regurgitant orifice

It´s used to calculate: EROA
A5C (Apical 5 chamber) or PLAX (Parasternal long axis)

Zoom mode (focused on aortic valve)

Diastole (ECG: The end of T wave - R wave)
Color doppler

Nyquist limit (Aliasing velocity): 30-40cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Va

Aliasing velocity

Manually set value on the echocardiography machine.
It´s used to calculate: EROA.
Nyquist limit: 50-70cm/s

Baseline is shifted in the direction of aortic regurgitation jet to 30-40cm/s.
Aliasing occurs: If the blood flow to the probe (red) exceeds the Va speed (38.5cm/s)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Apical 5 chamber (A5C), CW doppler of aortic valve

Vmax AR

Peak aortic regurgitation velocity

It´s used to calculate: EROA.
A5C (Apical 5 chamber)
Diastole (ECG: The end of T wave - R wave)
CW doppler

Place the cursor between aortic leaflet tips.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic regurgitation VCW (Vena contracta width)

echo PLAX view - zoom aortic valve, diastole

VCW

Vena contracta width

Narrowest portion of jet as emerges from aortic orifice.
Vena contracta is diameter of EROA (Effective Regurgitant Orifice Area).
PLAX (zoomed AV)
Diastole (ECG: The end of T wave - R wave)
Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation jet width (Regurgitation jet width)

LVOT diameter (Left ventricular outflow tract diameter)

RegJet_{width in LVOT} = RegJet_width/LVOT_diameter x 100

Regurgitation jet width in left ventricular outflow tract

Is the percentage regurgitant jet width in the LVOT

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RegJet_width

Regurgitation jet width

It´s used to calculate: RegJet_{width in LVOT}
PLAX (zoomed AV)
Diastole (ECG: The end of T wave - R wave)
Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

Measured in LVOT 1cm from vena contracta.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

LVOT_diameter

Left ventricular outflow tract diameter

It´s used to calculate: CSA_LVOT, SV_AoV a RegJet_{width in LVOT}, AVA
PLAX (zoomed AV)
Mid-systole (ECG: The beginning of T wave)
Measured in LVOT 5mm from aortic annulus.

Excluded calcium from the diameter measurement.

Method: Inner edge to inner edge

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic regurgitation jet CSA (Regurgitation jet cross section area)

CSA_{RegJet in CSA LVOT}

Regurgitation jet cross section area (CSA) in LVOT CSA

Is the percentage area of the jet to the LVOT area.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

CSA_RegJet

Regurgitation jet cross section area

It´s used to calculate: CSA_{RegJet in CSA LVOT}.
PSAX (level great vessels) zoomed AV
Diastole (ECG: The end of T wave - R wave)
Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

Measured in LVOT 1cm from vena contracta.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

RegJet_{soft density}

Regurgitant jet soft density

Density and contour of regurgitant jet

Density is proportional to the number of red blood cells reflecting the signal

A5C (Apical 5 chamber)
Diastole (ECG: The end of T wave - R wave)
CW doppler
Compare density with nonregurgitant flow
Dense signal suggests significant AR, whereas a faint signal is likely to be mild or trace AR.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

PHT_RegJet

Pressure half time of regurgitant jet

Pressure half-time (PHT) is defined as the time interval in milliseconds between the maximum gradient and the time point where the gradient is half the maximum initial value.
A5C (Apical 5 chamber)
Diastole (ECG: The end of T wave - R wave)
CW doppler
PHT is obtained by tracing the deceleration slope.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Suprasternal notch aortic arch - PW doppler

RevFlow_DesAo

Reversal holodiastolic flow in descending aorta

SSN window (aortic arch)
Diastole (ECG: The end of T wave - R wave)
PW doppler

Sample volume from proximal part of the descending aorta.

Suggest severe aortic regurgitation

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

VTI MV (Velocity time integral mitral valve inflow) PW doppler

SV_MV = CSA_MV x VTI MV

Stroke volume of mitral valve

It´s used to calculate: RegVol_AR
Calculate it in the top menu: MV

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

VTI LVOT (Velocity time integral of left ventricular outflow tract)

SV_AoV = CSA_LVOT x VTI_LVOT

Stroke volume via left ventricular outflow tract (aortic valve)

It´s used to calculate: RegVol_AR, RF_AR

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Apical 5 chamber (A5C), PW doppler of LVOT

VTI_LVOT

Velocity time integral of left ventricular outflow tract

It´s used to calculate: SV_AoV, AVA
A5C (Apical 5 chamber)
Systole (ECG: R wave - The end of T wave).
PW doppler

Sample volume from the center of the LVOT approximately 5 mm proximal to the aortic annulus.
Exactly to the level where the LVOT_diameter was measured.

Trace along the edge of the modal velocity to measure the area under the curve.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

RegVol_AR = SV_AoV - SV_MV

Regurgitant volume of aortic regurgitation

It´s used to calculate: RF_AR

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RF_AR = RegVol_AR / SV_AoV x 100

Regurgitant fraction

Regurgitation fraction of aortic regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Aortic regurgitation
	Mild	Moderate		Severe
Structural parameters
Aortic leaflets	Normal or abnormal	Normal or abnormal		Abnormal/flail, or wide coaptation defect
Left ventricle (Size)	Normal¹ (LVEDV ≤150ml male, ≤106ml female)	Normal or mild dilated		Usually dilated² (LVEDV >150ml male, >106ml female)
Qualitative doppler
RegJet_widht Regurgitation jet witdh	Small in central jets (Width in LVOT <25%)	Intermediate		Large in central jets; variable in eccentric jets (Width in LVOT >65%)
Flow convergence (PISAr)	None or very small (<0,3cm)	Intermediate		Large (≥1cm)
RegJet_density Regurgitant jet density (CW doppler)	Incomplete or faint	Dense		Dense
PHT_RegJet³ Pressure half time of regurgitant jet	Incomplete or faint Slow (>500ms)	Medium (200-500ms)		Steep <200ms
Diastolic reversal flow in descending aorta (PW doppler)	Brief, early diastolic reversal	Intermediate		Prominent holodiastolic reversal
Semiquantitative parameters⁴
VCW (cm) Vena contracta width	<0,3	0,3 - 0,6		>0,6
RegJet_{width in LVOT} (%) Regurgitation jet width in LVOT (centrel jets)	<25	25-45	46-64	≥65
CSA_{RegJet in CSA LVOT} (%) Regurgitation jet CSA in LVOT CSA (centrel jets)	<5	5-20	21-59	≥60
Quantitative parameters⁴
	Grade I	Grade II	Grade III	Grade IV
EROA (cm²) Effective regurgitant orifice area	<0,1	0,1 - 0,19	0,2 - 0,29	≥0,3
RegVol (ml) Regurgitant volume of aortic regurgitation	<30	30 - 44	45 - 59	≥60
RF (%) Regurgitant fraction of aortic valve	<30	30 - 39	40 - 49	≥50

Bolded qualitative and semiquantitative signs are considered specific for their AR grade. Color Doppler usually performed at a Nyquist limit of 50-70 cm/sec.

Unless there are other reasons for LV dilation.
Specific in normal LV function, in absence of causes of volume overload. Exception: acute AR, in which chambers have not had time to dilate.
PHT is shortened with increasing LV diastolic pressure and may be lengthened in chronic adaptation to severe AR.
Quantitative parameters can subclassify the moderate regurgitation group.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

LVEDV (Left ventricular end-diastole volume)

LVESV (Left ventricular end-systole volume)

LV EF = (LVEDV - LVESV) / LVEDV x 100

Left ventricular ejection fraction (Biplane Method of Discs)

Ejection fraction is the predominant method for assessing global systolic function

and is derived from the LVEDV and LVESV.

Calculate it in the top menu: Left ventricle

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Left ventricle (Ejection fraction)
	Male				Female
	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal
LV EF (%) Left ventricular ejection fraction (Biplane)	52 - 72	41 - 51	30 - 40	<30	54 - 74	41 - 53	30 - 40	<30

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Apical 4 Chamber View (A4C) zoomed left ventricle

LVEDV

Left ventricular end-diastole volume

A4C (zoomed left ventricle) and A2C (zoomed left ventricle).
End-diastole (ECG: R wave).
Preferred technique is Biplane Method of Discs (modified Simpson’s rule).
Measured from the A4C and A2C views (preferably an LV focused view) tracing the endocardial – blood pool interface

Papillary muscles should be excluded from the cavity tracing.
Maximize LV area and avoid foreshortening.

Calculate it in the top menu: Left ventricle

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Left ventricle (Volume)
	Male				Female
	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal	Normal range	Mildly abnormal	Moderately abnormal	Severely abnormal
LVEDV (ml) Left ventricular end-diastole volume (Biplane)	62 - 150	151 - 174	175 - 200	>200	46 - 106	107 - 120	121 - 130	>130
LVEDV (ml/m2) Left ventricular end-diastole volume (Biplane)	34 - 74	75 - 89	90 - 100	>100	29 - 61	62 - 70	71 - 80	>80
LVESV (ml) Left ventricular end-systole volume (Biplane)	21 - 61	62 - 73	74 - 85	>85	14 - 42	43 - 55	56 - 67	>67
LVESV (ml/m2) Left ventricular end-systole volume (Biplane)	11 - 31	32 - 38	39 - 45	>45	8 - 24	25 - 32	33 - 40	>40

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

VTI AoV

Velocity time integral aortic valve

It´s used to calculate: AVA
A5C (Apical 5 chamber).
Systole (ECG: R wave - The end of T wave).
CW doppler

Place the cursor in the middle of aortic valve.

Trace along the edge of the modal velocity to measure the area under the curve.

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Velocity time integral of left ventricular outflow tract

AVA = CSA_LVOT x VTI_LVOT / VTI AoV

Aortic valve area (continuity equation)

Aortic valve area calculation with the continuity equation formula is an indirect method of determining the area of the aortic valve (aortic valve area).

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic stenosis
	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	≤2,5	2,6 - 2,9	3,0 - 4,0	≥4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	≥40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Vmax_LVOT

Peak velocity Left ventricular aoutflow tract

It´s used to calculate: Velocity ratio
A5C (Apical 5 chamber)
Mid-systole (ECG: The beginning of T wave).
PW doppler

Sample volume from the center of the LVOT approximately 5 mm proximal to the aortic annulus.
Exactly to the level where the LVOT_diameter was measured.

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Vmax AoV

Aortic valve maximum velocity

It´s used to calculate: Velocity ratio
A5C (Apical 5 chamber).
Mid-systole (ECG: The beginning of T wave)
CW doppler

Place the cursor in the middle of aortic valve.

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic stenosis
	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	≤2,5	2,6 - 2,9	3,0 - 4,0	≥4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	≥40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Velocity ratio = Vmax_LVOT / Vmax AoV

Aortic valve velocity ratio (Dimensionless index)

Ratio of the subvalvular velocity obtained by PW doppler (Vmax_LVOT) and the maximum velocity obtained by CW doppler (Vmax AoV) across the aortic valve.
Also know as: Dimensionless index

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic stenosis
	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	≤2,5	2,6 - 2,9	3,0 - 4,0	≥4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	≥40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

maxPG AoV

Aortic valve peak pressure gradient

A5C (Apical 5 chamber).
Systole (ECG: R wave - The end of T wave).
CW doppler

Place the cursor in the middle of aortic valve.

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic stenosis
	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	≤2,5	2,6 - 2,9	3,0 - 4,0	≥4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	≥40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

meanPG AoV

Aortic valve mean pressure gradient

A5C (Apical 5 chamber).
Systole (ECG: R wave - The end of T wave).
CW doppler

Place the cursor in the middle of aortic valve.
Trace along the edge of the modal velocity to measure the area under the curve.

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Aortic stenosis
	Aortic sclerosis	Mild	Moderate	Severe
Vmax AoV (m/s) Aortic valve maximum velocity	≤2,5	2,6 - 2,9	3,0 - 4,0	≥4,0
meanPG AoV (mmHg) Aortic valve mean pressure gradient		<20	20 - 40	≥40
AVA (cm²) Aortic valve area (continuity equation)		>1,5	1,0 - 1,5	<1,0
AVA (cm²/m²) Aortic valve area (continuity equation)		>0,85	0,60 - 0,85	<0,60
Velocity ratio Aortic valve velocity ratio (Dimensionless index)		>0,5	0,25 - 0,5	<0,25

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

VTI_LVOT

Velocity time integral left ventricular outflow tract

A5C (Apical 5 chamber)
Systole (ECG: R wave - The end of T wave)
PW doppler

Sample volume from the center of the LVOT approximately 5 mm proximal to the aortic annulus.
Exactly to the level where the LVOT_diameter was measured.

Trace along the edge of the modal velocity to measure the area under the curve.

SV_AV = CSA_LVOT x VTI_LVOT

Stroke volume via left ventricular outflow tract (aortic valve)

Pulzový objem cez aortálnu chlopňu.

Echocardiography

Aortic valve

Va

VCW

PISAr

Vmax AR

EROA

RegJetwidth

LVOTdiameter

RegJetwidth in LVOT

CSARegJet

CSARegJet in CSA LVOT

RegJetsoft density

PHTRegJet

RevFlowDesAo

SVMV

VTILVOT

SVAoV

RegVolAR

RFAR

LV EF

LVEDV

VTI AoV

AVA

VmaxLVOT

Vmax AoV

Velocity ratio

maxPG AoV

meanPG AoV

EROA = 2π x PISAr2 x Va / Vmax AR

PISAr

Va

Vmax AR

VCW

RegJetwidth in LVOT = RegJetwidth/LVOTdiameter x 100

RegJetwidth

LVOTdiameter

CSARegJet in CSA LVOT

CSARegJet

RegJetsoft density

PHTRegJet

RevFlowDesAo

SVMV = CSAMV x VTI MV

SVAoV = CSALVOT x VTILVOT

VTILVOT

RegVolAR = SVAoV - SVMV

RFAR = RegVolAR / SVAoV x 100

LV EF = (LVEDV - LVESV) / LVEDV x 100

LVEDV

VTI AoV

AVA = CSALVOT x VTILVOT / VTI AoV

VmaxLVOT

Vmax AoV

Velocity ratio = VmaxLVOT / Vmax AoV

maxPG AoV

meanPG AoV

VTILVOT

SVAV = CSALVOT x VTILVOT

RegJet_width

LVOT_diameter

RegJet_{width in LVOT}

CSA_RegJet

CSA_{RegJet in CSA LVOT}

RegJet_{soft density}

PHT_RegJet

RevFlow_DesAo

SV_MV

VTI_LVOT

SV_AoV

RegVol_AR

RF_AR

Vmax_LVOT

EROA = 2π x PISAr² x Va / Vmax AR

RegJet_{width in LVOT} = RegJet_width/LVOT_diameter x 100

RegJet_width

LVOT_diameter

CSA_{RegJet in CSA LVOT}

CSA_RegJet

RegJet_{soft density}

PHT_RegJet

RevFlow_DesAo

SV_MV = CSA_MV x VTI MV

SV_AoV = CSA_LVOT x VTI_LVOT

VTI_LVOT

RegVol_AR = SV_AoV - SV_MV

RF_AR = RegVol_AR / SV_AoV x 100

AVA = CSA_LVOT x VTI_LVOT / VTI AoV

Vmax_LVOT

Velocity ratio = Vmax_LVOT / Vmax AoV

VTI_LVOT

SV_AV = CSA_LVOT x VTI_LVOT