Valvular & structural heart disease
Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation: Is It Time to Change the Guidelines?
Authors' conclusion
Patients with asymptomatic clinically significant chronic AR incur a survival penalty when Class I/IIa guideline recommendations are attained.
Study context
- Population
- Asymptomatic patients with chronic clinically significant (≥ moderate-severe) aortic regurgitation (AR), single referral centre, 2004–2019
- Participants
- 673 patients
- Exposure
- Class I/IIa guideline recommendations or markers of early left ventricular (LV) dysfunction vs no markers
- Outcome
- All-cause mortality
Methodological detailssingle referral centre
- Single referral centre
Main finding
As reported in the abstract
Mortality under surveillance
Each group vs no markersHazard ratio (95% CI)P value
Class I/IIa
4.22(2.15–8.29)
P < 0.05≥1 marker
2.18(1.21–3.92)
P < 0.05Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Mortality by number of markers, in absence of Class I/IIa recommendations (subgroup)All 3 markersvs No markers | 5.46 (2.51–11.90) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
- Mortality by number of markers, in absence of Class I/IIa recommendations (subgroup) — 1 marker: higher, not statistically significant, mortality vs no markers
- P = 0.063
Individual markers
- Left ventricular ejection fraction (LVEF) strongest association with mortality, statistically slightly better than global longitudinal strain (GLS) and indexed end-systolic volume (iESV)
Original publication
Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation: Is It Time to Change the Guidelines? JACC Cardiovasc Imaging. Published 13 November 2024. doi:10.
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