Abstract 5863: Rate and Correlates of Aortic Regurgitation Progression in a Cohort of 4128 Patients with Mild or Mild to Moderate Aortic Regurgitation
Background: Though the natural history of aortic stenosis is well studied, rate of progression of aortic regurgitation (AR) is not clear. This information is valuable for clinical decision making in patients with milder degrees of AR undergoing non aortic valve cardiac surgery.
Methods: Our echocardiographic database between the years 1993 and 2007 was screened for patients with 1 or 2+ AR who had follow up echocardiograms at least 3 months later. AR severity was graded 1–4 based on standard criteria. A change in AR grade was annualized.
Results: Of the 4128 patients, 3266 had 1+ and 862 had 2+ AR on the initial echocardiogram: age was 67±15 years, duration of follow up 4.2±2.7 years. Of those with 1+ AR on the initial echocardiogram, 95% had no change over a mean interval of 4.2 years and 2% increased the grade by ≥1+ per year. The average increase in AR grade was 0.04 per year. Of those with 2+ AR on initial echo, 90% had no change over this period and 2% increased the grade by ≥1+ per year. The average increase in grade was 0.07 per year. In the whole cohort, the AR progression correlated positively with age (p=0.03), ventricular septal thickness (p<0.0001), stroke distance (p=0.0003), increased transaortic velocity (p=0.01) and gradient (0.01) and initial AR severity (p<0.0001).
The rate of AR progression is extremely slow and prophylactic aortic valve replacement during non aortic surgery may not be indicated in those with 1 or 2+ AR.
AR progression seems to be higher in the elderly and those with aortic stenosis, higher cardiac output and greater AR severity.
On the average, it would take 25 years to progress from grade 1+ to 2+ AR and 14 years to progress from grade 2+ to 3+ assuming linear progression.