Mortality and morbidity of aortic regurgitation in clinical practice - A long-term follow-up study

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.