Author + information
- Received May 7, 2019
- Revision received July 25, 2019
- Accepted August 27, 2019
- Published online November 11, 2019.
- Li-Tan Yang, MDa,
- Maurice Enriquez-Sarano, MDa,
- Hector I. Michelena, MDa,
- Vuyisile T. Nkomo, MDa,
- Christopher G. Scott, MSb,
- Kent R. Bailey, PhDb,
- Didem Oguz, MDa,
- Muhammad Wajih Ullah, MDa and
- Patricia A. Pellikka, MDa,∗ (, )@MayoClinic@MayoClinicCV@pattypellikka
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Patricia A. Pellikka, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Background The natural history of stage B aortic regurgitation (AR) is unknown.
Objectives This study sought to examine determinants, rate, and consequences of progression of AR.
Methods Consecutive patients with ≤moderate chronic AR quantified by effective regurgitant orifice area (EROA) and regurgitant volume (RVol) from 2004 to 2017 who had ≥1 subsequent echocardiogram with quantitation were included.
Results Of 1,077 patients (66 ± 15 years of age), baseline trivial/mild AR was noted in 196 (18%), mild-to-moderate AR in 465 (43%), and moderate AR in 416 (39%); 10-year incidence of progression to ≥moderate-severe AR (stage C/D; progressors) was 12%, 30%, and 53%, respectively. At 4.1-year follow-up (interquartile range: 2.1 to 7.2 years), there were 228 progressors (21%), whose annualized progression rates within 3 years before diagnosis of ≥moderate-severe AR were 4.2 mm2/year for EROA and 9.9 ml/year for RVol. Baseline AR severity and dimensions of sinotubular junction and annulus were associated with progression (all p ≤ 0.007); hypertension and systolic blood pressure were not. Progressors had faster chamber remodeling, functional class decline, and more aortic valve/aortic surgery. At medium-term follow-up, 242 patients (22%) died; poor survival was linked to age, comorbidities, functional class, resting heart rate, and left ventricular (LV) ejection fraction (p ≤ 0.003), not LV end-systolic dimension index. Survival after progression to stage C/D AR was associated with LV end-systolic dimension index (adjusted p = 0.02).
Conclusions Progression from stage B to stage C/D AR was observed in 21% patients. Repeat echocardiography for trivial/mild, mild-to-moderate, and moderate AR at every 5, 3, and 1 years, respectively, was reasonable. EROA, RVol, annulus, and sinotubular junction should be routinely measured to estimate progression rates and identify patients at high risk of progression, which was associated with adverse consequences.
This work was supported by internal funds from the Mayo Clinic Department of Cardiovascular Medicine. Dr. Pellikka is the Betty Knight Scripps Professor in Cardiovascular Diseases Clinical Research, the professorship supported this research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 7, 2019.
- Revision received July 25, 2019.
- Accepted August 27, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.