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This table provides a concise overview of the guidelines for referral in cases of aortic stenosis and aortic regurgitation. It outlines specific conditions under which a referral for intervention should be considered, the tests and parameters to guide this decision, and the rationale behind these recommendations by NICE
| Condition | Criteria for Referral | Tests and Parameters | Rationale |
|---|---|---|---|
| Aortic Stenosis (Asymptomatic, Severe) | Consider referral for intervention | • Vmax > 5 m/s on echo • Aortic valve area < 0.6 cm on echo • LVEF < 55% • BNP or NT-proBNP > 2x upper limit of normal • Symptoms unmasked on exercise testing | High risk of progression and adverse events |
| Aortic Stenosis (Symptomatic, Low-Gradient with LVEF < 50%) | Consider referral for intervention | • Mean gradient > 40 mmHg and aortic valve area that remains less than 1cm2 during dobutamine stress echo | Severe stenosis confirmed during stress test |
| Aortic Stenosis (Symptomatic, Uncertain Severity) | Measure aortic valve calcium score | Cardiac CT | To clarify severity |
| Aortic Stenosis (Severe, with Mid-Wall Fibrosis) | Offer enhanced follow-up | Cardiac MRI | To monitor need for intervention |
| Aortic Regurgitation (Asymptomatic, Severe) | Consider referral for intervention | ♦ LVEF < 55% or ♦ ESD > 50 mm or ESDI > 24 mm/m2 on echo... |
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