Why the study?
Current surgical criteria for aortic regurgitation primarily rely on left ventricular remodeling, prompting the development and prognostic evaluation of a novel cardiac staging system.
Does a novel 5-stage cardiac staging system combined with global longitudinal strain effectively stratify risk for all-cause mortality, heart failure hospitalization, or cardiac surgery in patients with at least moderate aortic regurgitation?
Cohort (n=498)
No
Does a novel 5-stage cardiac staging system combined with global longitudinal strain effectively stratify risk for all-cause mortality, heart failure hospitalization, or cardiac surgery in patients with at least moderate aortic regurgitation?
A novel 5-stage cardiac damage staging system combined with left ventricular global longitudinal strain effectively stratifies prognosis in patients with moderate or greater aortic regurgitation, with strain providing the highest prognostic value in earlier stages.
May refine AR risk stratification with staging and GLS; extends prior systems but leaves impact on intervention timing open.
Background Aortic regurgitation (AR) is associated with heart failure and mortality; however, current surgical criteria primarily rely on left ventricular (LV) remodeling. Objectives We aimed to propose a novel cardiac stage and evaluate its prognostic value. Methods We retrospectively enrolled 498 patients with at least moderate AR at a single tertiary referral center between 2006 and 2022. We categorized cardiac damage into five stages (0-4), ranging from no abnormality to right-sided involvement. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, or cardiac surgery. Outcomes were compared across stages using Kaplan-Meier analysis and Cox regression. Results Among 498 patients with at least moderate AR over a median follow-up of 5.1 years, advancing cardiac stage was associated with a graded increase in adverse events (per-stage adjusted HR 1.55, 95% CI 1.39–1.73). Global longitudinal strain (GLS) impairment remained independently associated with outcomes (adjusted HR 1.71, 95% CI 1.28–2.27), and a significant stage-by-GLS interaction (HR 1.53; p = 0.014) indicated that the prognostic contribution of GLS was greatest at earlier stages and diminished with advancing stage. Conclusion A novel cardiac staging system effectively stratifies risk in significant AR. Higher stages were associated with progressively worse outcomes. Impaired LV GLS provided its greatest prognostic value in the early stages, supporting its use for clinical risk assessment and optimal surgical timingPrimary outcome by cardiac staging of AR
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Park et al. (2026) conducted a cohort in Aortic regurgitation (n=498). Advancing cardiac stage (0-4) and global longitudinal strain (GLS) impairment vs. Lower cardiac stages (stage 0 with no abnormality) and preserved GLS was evaluated on Composite of all-cause mortality, heart failure hospitalization, or cardiac surgery (adjusted HR 1.55 per stage, 95% CI 1.39-1.73).
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