Valvular & structural heart disease
Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation
Authors' conclusion
In asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR-based LVES volume assessment performed favorably compared to LV diameters.
Study context
- Population
- Asymptomatic patients with moderate or severe aortic regurgitation (AR) on cardiac magnetic resonance (CMR) with preserved left ventricular ejection fraction (LVEF); surgery within 30 days of CMR excludedmedian age 60 y
- Participants
- 458 patients
- Outcome
- Development of symptoms or LVEF decrease to <50%, guideline indications for surgery based on LV dimensions, or death under medical management
Main finding
As reported in the abstract
Primary outcome; CMR thresholds · median follow-up 2.4 years (IQR: 0.9-5.3 years)
- Events
- 133
- Optimal threshold, regurgitant volume
- 47 mL
- Optimal threshold, regurgitant fraction
- 43%
- Optimal threshold, indexed LV end-systolic (iLVES) volume
- 43 mL/m²
- Optimal threshold, indexed LV end-diastolic volume
- 109 mL/m²
- Optimal threshold, iLVES diameter
- 2 cm/m²
- iLVES volume ≥43 mL/m², multivariable HR
- 2.53 (95% CI 1.75-3.66; P < 0.001)
Observational data: associations, not effects.
Secondary outcomes
Secondary outcome (primary excluding surgery for remodeling indications)
- iLVES diameter independently associated with primary but not secondary outcome
Original publication
Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation. J Am Coll Cardiol. Published 5 March 2023. doi:10.
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