Ks. Dujardin et al., Mortality and morbidity of aortic regurgitation in clinical practice - A long-term follow-up study, CIRCULATION, 99(14), 1999, pp. 1851-1857
Citations number
34
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The outcome of aortic regurgitation conservatively followed in c
linical practice is poorly defined.
Methods and Results-Long-term outcome of 246 patients with severe or modera
tely severe aortic regurgitation diagnosed by color Doppler echocardiograph
y was analyzed. With conservative management, mortality rate was higher tha
n expected (at 10 years, 34+/-5%, P<0.001) and morbidity was high (10-year
rates of 47+/-6% for heart failure and 62+/-4% for aortic valve surgery). A
t 10 years, 75+/-3% of patients had died or had surgery and 83+/-3% had had
cardiovascular events. In multivariate analysis, predictors of survival we
re age (P<0.001), functional class (P<0.001), comorbidity index (P=0.033),
atrial fibrillation (P=0.002), and left ventricular end-systolic diameter c
orrected for body surface area (P=0.025). Ejection fraction was also an ind
ependent predictor of overall survival, including postoperative follow-up o
f surgically treated patients (P<0.001). High risk during conservative trea
tment, with mortality rate in excess of that expected, was noted among pati
ents with severe, even transient, symptoms (24.6% yearly, P<0.001) but also
in those with mild (class IT) symptoms (6.3% yearly,P=0.02) and in asympto
matic patients with left ventricular ejection fraction <55% (5.8% yearly, P
=0.03) or with end-systolic diameter normalized to body surface area greate
r than or equal to 25 mm/m(2) (7.8% yearly, P=0.004). Surgery performed dur
ing follow-up was independently associated with reduced cardiovascular mort
ality (adjusted hazard ratio, 0.54; P=0.048).
Conclusions-Patients diagnosed with severe aortic regurgitation in clinical
practice incur excess mortality and high morbidity, underscoring the serio
us prognosis of the disease. Surgery, which reduces cardiac mortality rates
, should be considered promptly in high-risk patients.