Donovan and Starling developed an algorithm to aid in the management of a patient with asymptomatic aortic regurgitation. This can help determine the appropriate time to consider surgery.
Parameters:
(1) number of clinical factors
(2) left ventricular ejection fraction
(3) end systolic dimension of the left ventricle
(4) exercise capacity
Clinical factors:
(1) age in years
(2) cardiothoracic ratio
(3) left ventricular hypertrophy on the ECG
(4) cardiac index in liters per minute per square meter BSA
(5) left ventricular end-diastolic pressure in mm Hg
|
Clinical Factor |
Finding |
Points |
|
age in years |
<= 65 years of age |
0 |
|
|
> 65 years of age |
1 |
|
cardiothoracic ratio |
< 0.58 |
0 |
|
|
>= 0.58 |
1 |
|
left ventricular hypertrophy |
absent |
0 |
|
|
present |
1 |
|
cardiac index |
> 2.5 liters per minute per sq m |
0 |
|
|
<= 2.5 liters per min per sq m |
1 |
|
left ventricular end diastolic pressure |
<= 20 mm Hg |
0 |
|
|
> 20 mm Hg |
1 |
number of clinical factors =
= SUM(points for all 5 factors)
|
Parameter |
Finding |
Points |
|
number of clinical factors |
0 |
0 |
|
|
1 |
1 |
|
|
>= 2 |
2 |
|
left ventricular ejection fraction |
> 60% |
0 |
|
|
50 - 60% |
1 |
|
|
< 50% |
2 |
|
left ventricular end systolic dimension in mm |
< 45 mm |
0 |
|
|
45 - 55 mm |
1 |
|
|
> 55 mm |
2 |
|
exercise capacity |
preserved |
0 |
|
|
decreased |
2 |
total decision points =
= SUM(points for the 4 parameters)
Interpretation:
• minimum total decision points: 0
• maximum total decision points: 8
|
Total Points |
Management Recommendation |
|
0 or 1 |
evaluate the patient every 12 months |
|
2 |
evaluate the patient every 6 months |
|
>= 3 |
prepare the patient for surgery |
Specialty: Cardiology
ICD-10: ,
