September 1, 1983Open Access
View Full PaperThe natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function.
Key Result
Conservative management of asymptomatic severe aortic regurgitation with normal LV function yielded 0 deaths over a mean 49 months, with <4% per year requiring aortic valve replacement.
Study Design
Type
Cohort (n=77)
Structured PICO
P
Population
77 asymptomatic patients with severe aortic regurgitation and normal left ventricular function (normal LVEF at rest by radionuclide angiography and normal LV fractional shortening by echocardiography). 63 patients had 3+ to 4+ aortic regurgitation, and 14 had pulse pressures >70 mm Hg.
I
Intervention
Conservative management (natural history observation without operation)
O
Outcome
Death or need for aortic valve replacement (due to onset of symptoms or left ventricular dysfunction)hard clinical
In asymptomatic patients with severe aortic regurgitation and normal left ventricular function, prophylactic aortic valve replacement is not indicated as death is rare and surgical outcomes remain excellent when delayed until symptoms or left ventricular dysfunction develop.
Abstract
In asymptomatic patients with severe aortic regurgitation and normal left ventricular function, aortic valve replacement has been recommended to preserve left ventricular function. In such patients, however, the natural history without operation is unknown. We therefore performed serial studies in 77 asymptomatic patients with normal left ventricular ejection fraction at rest as determined by radionuclide angiography and normal left ventricular fractional shortening as determined by echo- cardiography; 63 patients had 3 + to 4 + aortic regurgitation visualized by aortic root cineangiography, and the other 14 patients had pulse pressures >70 mm Hg. During mean follow-up of 49 months (range 6 to 114) no patient died and 12 patients underwent aortic valve replacement because of the onset of symptoms (11 patients) or the onset of left ventricular dysfunction without symptoms (one patient). By life table analysis, the percent of patients who did not require operation was 90 3% ( + SE) at 3 years, 81 + 6% at 5 years, and 75 7% at 7 years. In the 12 who did have surgery there were no operative or late deaths (postoperative follow-up 8 to 75 months, mean 38), left ventricular ejection fraction increased (45 5% + SD preoperatively, 58 + 11 postoperatively; p < .001), and left ventricular diastolic dimension determined echocardiographically decreased (74 4 mm preoperative- ly, 52 + 5 mm postoperatively; p < .001). Thus, in asymptomatic patients with normal left ventricular function, death is rare, and less than 4% per year require aortic valve replacement because symptoms or left ventricular dysfunction develop. When aortic valve replacement is delayed until symptoms or left ventricular dysfunction develop, postoperative survival is excellent, and left ventricular size and function improve postoperatively. Hence, "prophylactic" aortic valve replacement to preserve left ventricular function should not be performed in asymptomatic patients with severe aortic regurgitation and normal left ventricular function.
Cite This Study
Bonow et al. (Thu,) conducted a cohort in Asymptomatic severe aortic regurgitation with normal left ventricular function (n=77). Observation (natural history) was evaluated on Requirement for aortic valve replacement. Conservative management of asymptomatic severe aortic regurgitation with normal LV function yielded 0 deaths over a mean 49 months, with <4% per year requiring aortic valve replacement.