title: Etiology impacts survival in patients with severe aortic regurgitation: results from a cohort of 756 patients.
abstract: OBJECTIVE
  Severe aortic regurgitation (AR) is caused by a variety of mechanisms, which include the degenerative process, bicuspid aortic valve (BAV), aortic root dilation, endocarditis or a combination of these. Their frequency in a contemporary clinical series, and their impact on survival, are currently unknown.
  
  
  METHODS
  The authors' echocardiographic database between 1993 and 2007 was screened for patients with severe AR, and yielded 756 patients. Detailed chart reviews were performed to acquire clinical and demographic data. Mortality data were obtained from the social security death index and analyzed as a function of the condition's etiology.
  
  
  RESULTS
  The probable etiologies for AR were: degenerative in 29% of patients, BAV in 10%, aortic root pathology in 11%, endocarditis in 10%, and mixed or unclear mechanism in 40%. Survival was a function of the etiology (p < 0.0001), with degenerative mechanism having the worst prognosis and BAV the best. This differential impact on mortality remained significant after adjusting for age, gender, coronary artery disease, diabetes mellitus, renal insufficiency, left ventricular ejection fraction and aortic valve replacement, using the Cox regression model (p < 0.0001).
  
  
  CONCLUSIONS
  Etiology has a significant independent impact on mortality in patients with severe AR, with the worst survival being seen in degenerative AR.
authors.affiliation: Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Reena
authors.initials: R
authors.lastname: Patel
authors.forename: Rami
authors.initials: R
authors.lastname: Turk
authors.forename: Ashvin R
authors.initials: AR
authors.lastname: Kamath
authors.forename: Unnati
authors.initials: U
authors.lastname: Sampath
authors.forename: Sumit
authors.initials: S
authors.lastname: Khandhar
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000150:complications