Echocardiographic criteria were present in 31.2% of severe AR patients but were not associated with prognosis, unlike age and LVEF which related to clinical events.
Do guideline-recommended echocardiographic criteria predict clinical events in patients with chronic severe aortic regurgitation?
Current guideline-recommended echocardiographic criteria for intervention in chronic severe aortic regurgitation have low prevalence and fail to demonstrate prognostic relevance, suggesting a need for alternative imaging parameters.
Absolute Event Rate: 0% vs 0%
Abstract Background Current clinical practice guidelines recommend some echocardiographic criteria (EchoCr) for indication of intervention in chronic severe aortic regurgitation (AR): LVEF ≤50%, and absolute or indexed left ventricular end-systolic diameter (LVESD or LVESDi) 50 mm or 25 mm/m2 respectively. However, there is controversy regarding their suitability and a potential replacement by other values or techniques. Purpose Our aim is to evaluate the prevalence and prognostic relevance of the aforementioned criteria in a contemporary population of chronic severe AR. Methods We conducted an observational retrospective study with all the consecutive patients diagnosed with chronic severe AR in our tertiary centre between 2017 and 2023. Echocardiographic parameters were carefully reviewed by an expert in cardiac imaging. Baseline characteristics and clinical events (valvular intervention, admission for heart failure and death) were collected from medical records. Association between the different categories and events were analyzed with chi square or t-Student tests as necessary. Results 157 patients with severe AR were finally included in the study (71 ±15 years old, 37.6 % women). 17.2% had bicuspid aortic valve, and 36.3% and 42% were associated with aortic root and ascending aorta dilation respectively. They showed an LVEF of 55±10% and 61.1% ventricular dilation by volume criteria. The prevalence of EchoCr was 31.2% in the overall population. Finally, 81 patients (51.6%) underwent valvular intervention, with the presence of symptoms as the main indication (52, 33.1%). For the final analysis severe aortic dilation as the indication for surgery (8, 5.1%) was excluded. The prevalence of EchoCr was significantly higher among patients with valvular intervention (43.8% vs 21.1%; p= 0.005), as well as the rest of the echocardiographic parameters (Table). Nevertheless, EchoCr were not associated with prognosis neither in the medical nor in the surgical treatment groups. Solely, age (83.7±9 vs 71.4±16.2; p0.001) and LVEF (52.7±12.8 vs 58.5±7.8%; p= 0.051) were related with clinical events in patients with conservative management. Conclusions EchoCr showed a low prevalence among patients with chronic severe AR and failed to demonstrate prognostic relevance in our series. Therefore, the search of alternative imaging parameters should be pursued in order to assist in the management of these patients. Table. Prevalence of echocardiographic criteria in relation to surgical intervention indication LVEF: left ventricular ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; LVESDi: left ventricular end-systolic diameter indexed; LVEDVi: left ventricular end-diastolic volume indexed; LVESVi: left ventricular end-systolic volume indexed; LV: left ventricle; EchoCr: echocardiographic criteria.Table
Ojeda et al. (Sat,) reported a other. Echocardiographic criteria were present in 31.2% of severe AR patients but were not associated with prognosis, unlike age and LVEF which related to clinical events.