Aortic stenosis cardiac-damage staging
Stages 0–4 · Integrated from LV, LA/mitral, pulmonary and RV findings
Normal range & thresholds
Généreux staging [58]:
| Stage | Damage |
|---|---|
| 0 | None |
| 1 | LV: LVMI >115 (M)/95 (F) g/m², E/e′ >14 or LVEF <50% |
| 2 | LA/mitral: LAVI >34 mL/m², ≥moderate MR or AF |
| 3 | Pulmonary vasculature/tricuspid: SPAP ≥60 mmHg or ≥moderate TR |
| 4 | RV: ≥moderate RV dysfunction |
Each higher stage carried stepwise higher mortality after AVR, also in symptomatic cohorts [58,103].
Pathophysiology
AS injures the heart upstream in sequence — ventricle, atrium, pulmonary circulation, right ventricle. The stage measures how far the pressure load has propagated, which predicts outcome beyond the valve area [58].
Raised by
- Longer duration, higher gradients, hypertension, CKD
Lowered by
—
Technique & pitfalls
- Every component from the standard study.
Pseudo-change & artefact
- Coexisting primary mitral or lung disease can stage without AS causation.
Treatment thresholds
- Supports earlier intervention in asymptomatic severe AS and Heart Team timing [6,103].
Next step
- CMR for fibrosis when undecided [86].
Drugs
None reverse AS damage besides intervention.
Reversibility
LV damage partially reverses after AVR; advanced stages less so.