Valvular & structural heart disease
Natural history of asymptomatic moderate or severe aortic regurgitation: a systematic review and meta-analysis
Authors' conclusion
Asymptomatic moderate/severe AR carries significant excess mortality irrespective of age, contradicting its historically benign reputation. Given the rarity of asymptomatic LV dysfunction, earlier intervention guided by more sensitive markers of LV damage may improve outcomes, although heterogeneity and study quality warrant cautious interpretation.
Study context
- Population
- Patients with asymptomatic moderate or severe aortic regurgitation (AR)patients in twenty-seven studies, mean age 49 years, mean follow-up 3.9 years
- Participants
- 4,720 patients
- Comparison
- Hazard ratios (HRs) of AVR vs conservative management
- Outcome
- Pooled incidence rates of adverse events (per 100 person-years)
- Follow-up
- Mean 3.9 years
Methodological detailscohort studies, random-effects models for pooled incidence rates, fixed-effects models for hazard ratios
- Cohort studies
- Random-effects models for pooled incidence rates
- Fixed-effects models for hazard ratios
Pooled result
As reported in the abstract
- All-cause mortality
- 1.75 (95% CI 1.27 to 2.41)
- Cardiac death
- 1.29
- Sudden death
- 0.29
- New symptoms
- 4.30
- AVR
- 7.01
- Asymptomatic low left ventricular ejection fraction
- 0.9
Further pooled results
| Outcome | Pooled HR (95% CI) | |
|---|---|---|
| MortalityEarly AVRvs conservative managementLower mortality with early AVR | 0.33 (0.30–0.37) | |
| 0.20.5125Pooled hazard ratio (log scale) |
Mortality by cohort mean age (per 100 person-years)
- Cohorts with mean age ≥50 years
- 2.45 (1.90 to 3.18)
- Younger cohorts
- 0.59 (0.29 to 1.21)
- Mortality rates more than double those of the general population across age groups
Original publication
Natural history of asymptomatic moderate or severe aortic regurgitation: a systematic review and meta-analysis. Heart. Published 17 November 2025. doi:10.
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