Abstract 236: Impact of Etiology on Survival in Patients With Severe Aortic Regurgitation: Results From a Cohort of 786 Patients
Background: Severe aortic regurgitation (AR) is caused by a variety of mechanisms, which include the degenerative process, bicuspid valve, aortic root dilation, endocarditis or a combination of processes. The frequency and prognostic implications of these etiological factors in patients with severe AR are not known.
Methods: Our echocardiographic database from 1993 to 2007 was screened for patients with severe AR. This yielded 786 patients. The etiology was determined through a detailed analysis of aortic leaflet and root. Chart reviews were performed to gain clinical and demographic data. Mortality data was obtained from social security death index.
Results: The likely etiologies for AR were as follows: degenerative in 30%, bicuspid aortic valve in 11%, aortic root pathology in 11%, endocarditis in 11% and mixed or unclear mechanism in 37%. As shown in the figure⇓, survival was a function of the etiology (p<0.0001), degenerative mechanism having the worst and bicuspid valve the best prognosis. This differential impact on mortality remained significant after adjusting for age, gender, coronary artery disease, diabetes mellitus, renal insufficiency, LV ejection fraction and aortic valve replacement using the Cox regression model (p<0.0001).
Etiology has a significant independent impact on mortality in patients with severe AR.
The best prognosis is seen in bicuspid valves and the worst in degenerative AR.