Key result
In asymptomatic patients with moderate aortic stenosis, moderate/severe aortic regurgitation reduced 4-year survival free of death, symptoms, or AVR (HR 2.21; 95% CI 1.31-3.74; p=0.003).
Why the study?
Does concomitant aortic regurgitation worsen clinical outcomes in asymptomatic patients with moderate or severe aortic stenosis?
Cohort (n=308)
No
Does concomitant aortic regurgitation worsen clinical outcomes in asymptomatic patients with moderate or severe aortic stenosis?
Hazard Ratio: 2.21 (95% CI 1.31–3.74)
Absolute Event Rate: 29% vs 47.1%
p-value: p=0.003
Concomitant moderate/severe aortic regurgitation accelerates the progression to symptoms or need for valve replacement in asymptomatic patients with moderate, but not severe, aortic stenosis.
May warrant closer surveillance in moderate AS with AR; leaves open whether AR modifies intervention thresholds.
Background The pathologic processes of aortic regurgitation (AR) and aortic stenosis (AS) can affect the rate of progression to symptoms differently, and insight into the management of mixed aortic disease is needed. We examined the impact of concomitant AR in asymptomatic patients with AS. Methods We examined 308 asymptomatic patients (mean age, 76 ± 13 yrs; 62% men) with moderate or severe AS seen at our institution, and compared outcomes according to the presence of AR. Results Over 5.5 [2.7, 6.7] years, the presence of AR significantly impacted outcomes in patients with moderate, but not severe AS. For patients with moderate AS, the 4-year survival free of death, cardiac symptoms, or aortic valve replacement (AVR) was 47.1%, 30.9%, and 29.0% for none, mild, and moderate/severe AR, respectively ( p = 0.02), and this relation remained significant after adjustment for morbidities in multivariate analyses (HR, 2.21 [1.31–3.74] for moderate/severe AR, p = 0.003). The median time to symptom onset was shorter with worse AR in patients with moderate AS (34.8, 32.1, and 24.0 months for none, mild, and moderate/severe AR, respectively; p = 0.08). There was no relation of concomitant AR to increased risk of death, symptoms, and AVR in patients with severe AS. Conclusion The presence of AR increases the risk of need for AVR, but not death, in patients with moderate AS. Asymptomatic patients with severe AS have comparable long-term outcomes regardless of AR severity. These data have implications for clinical follow up and timing of surgery.
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Sorajja et al. (2018) conducted a cohort in Asymptomatic native aortic valve stenosis (n=308). Moderate/severe aortic regurgitation vs. No aortic regurgitation was evaluated on 4-year survival free of death, cardiac symptoms, or aortic valve replacement (AVR) (HR 2.21, 95% CI 1.31-3.74, p=0.003). In asymptomatic patients with moderate aortic stenosis, moderate/severe aortic regurgitation reduced 4-year survival free of death, symptoms, or AVR (HR 2.21; 95% CI 1.31-3.74; p=0.003).
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