CLINICAL STATEMENTS AND GUIDELINES 4.3. Chronic AR 4.3.1. Diagnosis of Chronic AR Recommendations for Diagnostic Testing of Chronic AR Referenced studies that support the recommendations are summarized in Online Data Supplement 14. COR LOE Recommendations In patients with signs or symptoms of AR, TTE is indicated for assessment of the cause and severity of regurgitation, LV size and systolic function, prognosis, and timing of valve In patients with a BAV or with known dilation of the aortic sinuses or ascending aorta, TTE is indicated to evaluate the presence and severity In patients with moderate or severe AR and suboptimal TTE images or a discrepancy between clinical and TTE findings, TEE, CMR, or cardiac catheterization is indicated for the assessment of LV systolic function, systolic and diastolic volumes, aortic size, and AR severity.20 25 Synopsis TTE provides diagnostic information about the etiology and mechanism of AR (including valve reparability), se- verity of regurgitation, morphology of the ascending aorta, and LV response to the increases in preload and afterload. Imaging with TEE, CMR, or aortic angiogra- phy provides additional information when needed. Recommendation-Specific Supportive Text 1. Although qualitative measures of AR severity are adequate in many situations, when AR is signifi- cant (Stages B and C), quantitative measures of regurgitant volume and effective regurgitant orifice (ERO) area1 are better predictors of clini- Measures of LV systolic function (LVEF or fractional shortening) and LV end-systolic dimension (LVESD) or LV end-systolic volume are predictive of the development of HF symptoms or death in initially asymptomatic patients (Stages B and C1) and are significant determinants of survival and functional results after surgery in asymptomatic and symptomatic patients (Stages Symptomatic patients (Stage D) with normal LVEF have a significantly better long- term postoperative survival rate than those with depressed systolic function. 2. 