European heart journal. Cardiovascular Imaging · 2026
Prognostic implications of moderate aortic stenosis with concomitant aortic regurgitation in degenerative aortic valve disease: insights from a multicentre cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Son Jihee, Kim Jihoon, Kim Eun Kyoung, Chang Sung-A, Lee Sang-Chol, Park Seung Woo, Lim Jaehyun, Kwak Soongu, Park Jun-Bean, Lee Seung-Pyo, Kim Hyung-Kwan, Kim Kyu, Cho Iksung, Hong Geu-Ru, Shim Chi Young, Park Sung-Ji
Аннотация
AIMS: Mixed aortic valve disease poses unique haemodynamic challenges. This study compared the clinical outcomes of concomitant moderate aortic stenosis (AS) and moderate aortic regurgitation to isolated AS.
METHODS AND RESULTS: We analysed a multicentre cohort of valvular heart disease between 2008 and 2022 at three tertiary centres. The entire cohort was divided into three groups: moderate AS accompanied by moderate aortic regurgitation (moderate ASR), isolated severe AS, and isolated moderate AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. The final analysis included 4395 patients (median age: 76 years, 50.8% male), comprising 224 patients with moderate ASR, 1996 with severe AS, and 2175 with moderate AS. Over a median follow-up of 3.4 years, aortic valve replacement (AVR) rates were 11.1, 57.2, and 7.8 per 100 person-years in the moderate ASR, severe AS, and moderate AS groups, respectively (P < 0.001). Patients with moderate ASR had a significantly higher risk of the primary outcome compared with moderate AS [adjusted hazard ratio (aHR) 1.49; 95% confidence interval (CI) 1.15-1.92; P = 0.002] and a risk comparable to severe AS (aHR 1.28; 95% CI 1.00-1.64; P = 0.052). These results remained consistent even when AVR was included as a time-varying covariate. Older age, male sex, renal dysfunction, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with moderate ASR.
CONCLUSION: Moderate ASR should not be considered a benign condition, as it is associated with poor clinical outcomes comparable to those of severe AS.
METHODS AND RESULTS: We analysed a multicentre cohort of valvular heart disease between 2008 and 2022 at three tertiary centres. The entire cohort was divided into three groups: moderate AS accompanied by moderate aortic regurgitation (moderate ASR), isolated severe AS, and isolated moderate AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. The final analysis included 4395 patients (median age: 76 years, 50.8% male), comprising 224 patients with moderate ASR, 1996 with severe AS, and 2175 with moderate AS. Over a median follow-up of 3.4 years, aortic valve replacement (AVR) rates were 11.1, 57.2, and 7.8 per 100 person-years in the moderate ASR, severe AS, and moderate AS groups, respectively (P < 0.001). Patients with moderate ASR had a significantly higher risk of the primary outcome compared with moderate AS [adjusted hazard ratio (aHR) 1.49; 95% confidence interval (CI) 1.15-1.92; P = 0.002] and a risk comparable to severe AS (aHR 1.28; 95% CI 1.00-1.64; P = 0.052). These results remained consistent even when AVR was included as a time-varying covariate. Older age, male sex, renal dysfunction, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with moderate ASR.
CONCLUSION: Moderate ASR should not be considered a benign condition, as it is associated with poor clinical outcomes comparable to those of severe AS.