New Cardiovascular Damage Staging Classification for Chronic Significant Aortic Regurgitation.

BACKGROUND

Current recommendations for management of chronic aortic regurgitation (AR) are based on AR severity, symptoms and repercussions on the left ventricle (LV), only providing modest risk stratification value in patients with AR. The objective was to assess the prognostic value of a new staging classification characterizing the extent of cardiovascular damage for risk stratification in patients with chronic AR.

METHODS

According to cardiovascular damages at echocardiography, 619 patients with ≥ moderate AR were classified as follows: Stage 0: no cardiovascular damage; Stage 1: LV damage; Stage 2: ascending aorta, left atrial, or mitral valve damage; Stage 3: pulmonary vasculature or tricuspid valve damage; and Stage 4: right ventricular damage. Study primary endpoint was all-cause mortality and the secondary endpoint was a composite of all-cause mortality and cardiovascular hospitalization.

RESULTS

Among 619 patients, 85 (13.7%) were in Stage 0, 138 (22.3%) in Stage 1, 278 (44.9%) in Stage 2, 35 (5.7%) in Stage 3, and 83 (13.4%) in Stage 4. After adjustments, cardiovascular damage stage was independently associated with increased risk of all-cause mortality (hazard ratio [HR]; 95% confidence interval [CI] per 1 stage increase, 1.49 [1.27 to 1.75]; P < 0.001) and the composite of events (HR,1.17 [1.03-1.34]; P = 0.02). Stage ≥ 2 was independently associated with increased risk of all-cause mortality (HR, 3.02 [1.83-4.99]; P < 0.001) and the composite of events (HR, 1.88 [1.29-2.73]; P < 0.001). Net reclassification index analyses showed incremental value of the new classification (net reclassification index [NRI] = 0.40; P < 0.001).

CONCLUSIONS

This new cardiovascular damage staging classification provides powerful prognostic value in patients with chronic AR and may be useful to enhance risk stratification and trigger intervention, particularly in asymptomatic AR.