Slow rate of progression of grade 1 and 2+ aortic regurgitation.
OBJECTIVE
Although the progression of aortic stenosis has been well studied, the rate of progression of aortic regurgitation (AR) has not been definitively established. Further data would be valuable for clinical decision-making in patients with milder degrees of AR undergoing non-aortic valve cardiac surgery. Hence, this point was investigated in a large cohort of patients with grade 1 or 2+ AR.


METHODS
The authors' echocardiographic database acquired between 1993 and 2007 was screened for patients with grade 1 or 2+ AR who had undergone follow up echocardiography at least one year later. The AR severity was graded as 1 to 4+, and any annual changes in AR grade were monitored.


RESULTS
Among a total of 4,128 patients identified, 3,266 had grade 1+ AR and 862 had grade 2+ AR on the initial echocardiogram: the mean age was 67 +/- 15 years, and the duration of follow up was 4.2 +/- 2.7 years. Of those patients initially with grade 1+ AR, 95% showed no change in AR over a mean interval of 4.2 years, with an annual average increase in AR grade of 0.04. Of those patients initially with grade 2+ AR, 90% showed no change over this period, with an annual average increase in grade of 0.07. In the entire cohort, the AR progression correlated positively with age (p = 0.03), ventricular septal thickness (p < 0.0001), stroke distance (the time velocity integral of flow in the left ventricular outflow tract) (p = 0.0003), the presence of any degree of aortic stenosis (p = 0.01), and initial AR severity (p < 0.0001).


CONCLUSIONS
The rate of AR progression is extremely slow, and prophylactic aortic valve replacement during non-aortic surgery may not be indicated in patients with grade 1 or 2+ AR in the absence of any higher risk for progression, such as grade 2+ AR combined with any degree of aortic stenosis and advanced age.
Heart Valve Center, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Reena
R
Patel
Ashvin
A
Kamath
Padmini
P
Varadarajan
Srikanth
S
Krishnan
Ramdas G
RG
Pai
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors