Abstract 11229: Are Guidelines Criteria for Aortic Regurgiation still Appropriate ? Results of a Natural History Study
Background. Indications for surgery in patients with severe AR are based on the results of a few natural history studies that were conducted before modern heart failure treatments and imaging modalities were widely available. Accordingly, the aim of the present work was to test if the criteria used to propose surgery by the guidelines are still appropriate in present times.
Methods and Results. 489 patients with severe AR by Doppler echocardiography were recruited between january 1995 and december 2010. Patients were censored at the time of aortic valve surgery. Overall survival of the whole population was found to be less than that of the age- and gender matched Belgian population (83% vs 93%, log rank p<0.001). Multivariate cox proportional hazard analysis identified age, diabetes mellitus, NYHA, gender and LV ejection fraction (EF) as independent predictors of 6-year survival. Kaplan Meier survival curves confirmed that patients in NYHA I-II, those with a LVEF > 50% and those with LV end-systolic dimensions (ESD) < 25 mm/m² has significantly better overall survival that patients in NYHA III-IV, a LVEF < 50% or LVESD > 25 mm/m² (p<0.001, p=0.002, p=0.008 respectively). Age adjustments yielded similar results. Among the 175 initially asymptomatic patients who were followed up conservatively, the annualized risk of developing asymptomatic LV dysfunction was 0.5%/year, that of symptomatic deterioration was 2%/year and the need for surgery was 5%/year. These figures are quite similar to those reported in the literature.
Conclusion. Despite significant improvements in heart failure treatments and imaging modalities, the spontaneous outcome of patients with severe AR, in the absence of surgical correction, still depends on their symptomatic status, their initial LV function and and their initial LV end-systolic dimensions, with similar cutoffs values as those reported in the guidelines. This suggests that current indications for surgery, as outlined in the guidelines are still aprropriate.
- © 2012 by American Heart Association, Inc.