Outcomes in Chronic Hemodynamically Significant Aortic Regurgitation and Limitations of Current Guidelines

• Published in: Journal of the American College of Cardiology 2019-04, Vol.73 (14), p.1741-1752
• Main Authors: Yang, Li-Tan, Michelena, Hector I., Scott, Christopher G., Enriquez-Sarano, Maurice, Pislaru, Sorin V., Schaff, Hartzell V., Pellikka, Patricia A.
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; aortic regurgitation; Aortic valve; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - therapy; Cardiac arrhythmia; Cardiology; Cardiomyopathy; Cardiovascular disease; Comorbidity; Confidence intervals; Conservative Treatment - methods; Conservative Treatment - statistics & numerical data; Coronary artery; Coronary artery disease; Coronary vessels; echocardiography; Echocardiography - methods; Endocarditis; Family medical history; Female; guideline; Heart; Heart diseases; Heart surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - statistics & numerical data; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Hemodynamics; Humans; Integrated approach; left ventricular dimension; Male; Medical prognosis; Middle Aged; Mortality; Myocardial infarction; Patients; Practice Guidelines as Topic; prognosis; Regurgitation; Retrospective Studies; Rheumatic heart disease; Risk Factors; Severity of Illness Index; Signs and symptoms; Stroke Volume; Surgery; Survival; Survival Analysis; Ultrasonic imaging; Ventricle
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.01.024

Few data exist on the contemporary profiles and outcomes of patients with significant aortic regurgitation (AR). This study sought to assess the benefits of aortic valve repair or replacement (AVR) and the prognostic value of left ventricular (LV) dimensions in significant AR. From 2006 to 2017, consecutive patients with ≥moderate-severe chronic AR without prior heart surgery, myocardial infarction, or overt coronary artery disease were included. Of 748 participants (58 ± 17 years of age; 82% men), 387 (52%) were medically treated, and 361 (48%) had AVR. Of 361 patients having AVR, 334 (93%) met guideline criteria: Class I indications in 284 (79%) patients, which included symptoms in 236, and Class II indications in 50 (14%). The remaining 27 (7%) opted for surgery without Class I or II indications. At a median follow-up of 4.9 years (interquartile range: 2.3 to 8.3 years), 125 (17%) patients had died. Age, comorbidities, baseline symptoms, and higher LV end-systolic dimension index (LVESDi) were associated with all-cause mortality (all p ≤ 0.01). Compared with patients having LVESDi