DBP, heart rate predict mortality in chronic aortic regurgitation

Diastolic blood pressure (DBP) and resting heart rate (RHR) in patients with haemodynamically significant aortic regurgitation (AR) strongly predict all-cause mortality, independent of demographics, comorbidities, guideline-based surgical triggers, presence of hypertension and use of medications, suggests a new study.

“Therefore, DBP and RHR should be integrated into comprehensive clinical decision making for these patients,” the authors said.

From 2006 to 2017, 820 consecutive patients (mean age, 59±17 years; 82 percent men) with moderate-to-severe AR were retrospectively identified and followed for 5.5±3.5 years. Of these, 104 succumbed to death under medical management, and 400 underwent aortic valve surgery (AVS).

Age, symptoms, left ventricular ejection fraction (LVEF), LV end-systolic diameter-index (LVESDi), DBP and RHR were independently associated with all-cause mortality (p-all≤0.002).

After adjusting for demographics, comorbidities and surgical triggers (ie, symptoms, LVEF and LVESDi), only baseline DBP (adjusted hazard ratio [aHR] per 10-mm Hg increase, 0.79, 95 percent confidence interval [CI], 0.66–0.94; p=0.009) and baseline RHR (adjusted HR per 10 beat per min [bpm] increase, 1.23, 95 percent CI, 1.03–1.45; p=0.01) independently predicted all-cause death.

“These associations persisted after adjustment for presence of hypertension, medications, time-dependent AVS, and using average DBP and RHR (p-all≤0.02),” the authors said.

Furthermore, patients with AR, compared with the general population, demonstrated higher mortality (relative risk of death, >1), which further increased in inverse proportion (p-nonlinearity=0.002) to DBP starting at 70 mm Hg and peaking at 55 mm Hg and in direct proportion to RHR starting at 60 bpm.