Baseline severity, sinotubular junction dimension predict progression in aortic regurgitation

A study has shown disease progression in 21 percent of patients with aortic regurgitation (AR) from stage B to stage C/D, and this progression is associated with baseline AR severity and dimensions of sinotubular junction and annulus.

“Repeat echocardiography for trivial/mild, mild-to-moderate and moderate AR at every 5, 3 and 1 years, respectively, was reasonable,” the authors said.

This study included 1,077 consecutive patients (age, 66±15 years) with ≤moderate chronic AR, quantified by effective regurgitant orifice area (EROA) and regurgitant volume (RVol) from 2004 to 2017, who had one or more subsequent echocardiogram with quantitation.

Of the patients, 196 (18 percent) had baseline trivial/mild AR, 465 (43 percent) had mild-to-moderate AR and 416 (39 percent) had moderate AR. The 10-year incidence of progression to ≥moderate-to-severe AR (stage C/D; progressors) was 12 percent, 30 percent and 53 percent, respectively.

There were 228 progressors (21 percent) at a follow-up of 4.1 years (interquartile range, 2.1–7.2 years). Their annualized progression rates within 3 years before diagnosis of ≥moderate-to-severe AR were 4.2 mm²/year for EROA and 9.9 ml/year for RVol.

Progression was predicted by baseline AR severity and dimensions of sinotubular junction and annulus, but not hypertension and systolic blood pressure. Moreover, progressors had faster chamber remodeling and functional class decline and underwent more valve/aortic surgery.

Of the patients, 242 (22 percent) died at medium-term follow-up. Age, comorbidities, functional class, resting heart rate and left ventricular (LV) ejection fraction (p≤0.003), but not LV end-systolic dimension index, were associated with poor survival. Survival after progression to stage C/D AR correlated with LV-end-systolic dimension index (p-adjusted=0.02).

“EROA, RVol, annulus and sinotubular junction should be routinely measured to estimate progression rates and identify patients at high risk of progression, which was associated with adverse consequences,” the authors said.