Mixed aortic valve disease was associated with a higher risk of cardiac death or heart failure hospitalization compared to moderate AS (aHR 1.47; 95% CI 1.16-1.89; p=0.002).
Cohort (n=4,395)
Yes
Does moderate aortic stenosis with concomitant moderate aortic regurgitation worsen clinical outcomes compared to isolated moderate or severe aortic stenosis?
Patients with moderate aortic stenosis and concomitant moderate aortic regurgitation have a risk of cardiac death and heart failure hospitalization comparable to those with severe aortic stenosis, highlighting a high-risk population that may be undertreated.
Hazard Ratio: 1.47 (95% CI 1.16–1.89)
p-value: p=0.002
Abstract Background Mixed aortic valve disease (MAVD) poses unique hemodynamic challenges. Objectives This study compared the clinical outcomes of concomitant moderate aortic stenosis (AS) and moderate aortic regurgitation (AR) to isolated AS. Methods We analyzed a multicenter cohort of valvular heart disease between 2008 and 2022 at three tertiary centers. MAVD was defined as moderate AS accompanied by moderate aortic regurgitation (ASR). The entire cohort was divided into three groups; MAVD, isolated moderate AS and isolated severe AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. Statistical analyses included Kaplan-Meier estimation with log-rank tests, Cox proportional hazards models adjusting for baseline covariates, and a time-dependent Cox model for AVR. Independent predictors were identified using multivariable Cox regression. Results The final analysis included 4,395 patients (median age: 76 years, 50.8% male), comprising 224 patients with MAVD, 1,996 with severe AS, and 2,175 with moderate AS. Over a median follow-up of 3.4 years, AVR rates were 11.1, 57.2, and 7.8 per 100 person-years in the MAVD, severe AS, and moderate AS groups, respectively (p0.001). Patients with MAVD had a significantly higher risk of the primary outcome compared to moderate AS (adjusted hazard ratio aHR 1.47; 95% confidence interval CI 1.16–1.89; p=0.002) and a risk comparable to severe AS (aHR 1.23; 95% CI, 0.97–1.59; p=0.081). These results remained consistent even when aortic valve replacement was included as a time-varying covariate. Older age, male sex, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with MAVD. Conclusions Patients with moderate ASR exhibited poor clinical outcomes comparable to those of severe AS, with a lower rate of AVR.
Son et al. (2025) conducted a cohort in Valvular heart disease (mixed aortic valve disease) (n=4,395). Mixed aortic valve disease (moderate AS with moderate AR) vs. Isolated moderate AS and isolated severe AS was evaluated on Composite of cardiac death and hospitalization for heart failure (aHR 1.47, 95% CI 1.16-1.89, p=0.002). Mixed aortic valve disease was associated with a higher risk of cardiac death or heart failure hospitalization compared to moderate AS (aHR 1.47; 95% CI 1.16-1.89; p=0.002).