(Circulation. 1999;99:1851-1857.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Mortality and Morbidity of Aortic Regurgitation in Clinical Practice
A Long-Term Follow-Up Study
From the Division of Cardiovascular Diseases and Internal Medicine (K.S.D., M.E.-S., J.B.S., A.J.T.), Section of Cardiovascular Surgery (H.V.S.), and the Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Correspondence to Maurice Enriquez-Sarano, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Background—The outcome of aortic regurgitation conservatively followed in clinical practice is poorly defined.
Methods and Results—Long-term outcome of 246 patients with severe
or moderately severe aortic regurgitation diagnosed by
color Doppler echocardiography was
analyzed. With conservative management, mortality rate was
higher than 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). At 10 years, 75±3% of patients had
died or had surgery and 83±3% had had cardiovascular
events. In multivariate analysis, predictors of
survival were 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 corrected for
body surface area (P=0.025). Ejection fraction was also
an independent predictor of overall survival, including postoperative
follow-up of surgically treated patients (P<0.001).
High risk during conservative treatment, with mortality rate in excess
of that expected, was noted among patients with severe, even transient,
symptoms (24.6% yearly, P<0.001) but also in those
with mild (class II) symptoms (6.3% yearly, P=0.02) and
in asymptomatic patients with left ventricular
ejection fraction <55% (5.8% yearly, P=0.03) or with
end-systolic diameter normalized to body surface area 
25
mm/m2 (7.8% yearly, P=0.004). Surgery
performed during follow-up was independently associated with reduced
cardiovascular mortality (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 serious prognosis of the disease. Surgery, which reduces cardiac mortality rates, should be considered promptly in high-risk patients.
Key Words: aorta • prognosis • regurgitation • surgery • survival
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