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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Diagnosis and initial evaluation of aortic regurgitation (AR) Class I - There is evidence and/or generalagreement that the following tests are indicated for the diagnosis andinitial evaluation in patients with AR •  Echocardiography 1. To confirm the diagnosis and to estimate the severity of acute or chronic AR. 2. To determine the cause of chronic AR, includingassessment of valve morphology and the size and morphology of theaortic root. 3. To determine left ventricular function anddetect left ventricular hypertrophy and left ventricular dimensions orvolumes in chronic AR. 4. Among patients with an enlarged aortic root, to assess both AR and the severity of aortic dilatation. 5. Among asymptomatic patients with chronic AR, to periodically reevaluate left ventricular size and function. 6. To reassess mild, moderate, or severe AR in patients who have new or changing symptoms. •  Radionuclide angiography or magnetic resonance imaging 1. For the initial and follow-up assessment of left ventricular volume and function at rest when echocardiography is suboptimal. •  Cardiac catheterization 1. With aortic root angiography and measurement ofleft ventricular pressure to assess the severity of AR, leftventricular function, and aortic root size when noninvasive tests areinconclusive or provide discrepant results from clinical findings. Class IIa - The weight of evidence oropinion is in favor of efficacy of the following tests in patients withAR in the following settings •  Exercise stress testing in chronic AR 1. To assess functional capacity and symptom response in patients with a history of equivocal symptoms. 2. To assess symptoms and functional capacity prior to participation in athletic activity. •  Magnetic resonance imaging 1. To assess the severity of AR when echocardiography is not satisfactory. Class IIb - The weight of evidence oropinion is less well established for the following test in patientswith AR in the following setting •  Exercise stress testing with radionuclide angiography 1. To assess left ventricular function in asymptomatic or symptomatic patients with chronic AR. Class III - There is evidence and/orgeneral agreement that the following test is not useful in patientswith AR in the following settings •  Cardiac catheterization 1. When noninvasive tests are adequate and consistent with clinical findings and coronary angiography is not required.

1. To assess left ventricular function in asymptomatic or symptomatic patients with chronic AR. Class III - There is evidence and/orgeneral agreement that the following test is not useful in patientswith AR in the following settings •  Cardiac catheterization 1. When noninvasive tests are adequate and consistent with clinical findings and coronary angiography is not required. 2. In asymptomatic patients in whom noninvasive tests are adequate. Data from Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.