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Staging cardiac damage in patients with aortic regurgitation

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Abstract

The impact of “downstream” pathophysiological cardiac consequences in aortic regurgitation patients were not well established. The aim of our study was to validate a staging system built for severe aortic stenosis in a large real-world cohort of aortic regurgitation (AR) patients, evaluating the prevalence of different stages of cardiac damage and assess its prognostic impact. Clinical, echocardiographic and outcome data of patients with moderate-severe AR who underwent transthoracic echocardiography between January/2014 and September/2019 were retrospectively analysed. Patients were classified according to the extent of cardiac damage: Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) and Stage 4 (right ventricular damage). The primary endpoint was all-cause mortality. A total of 571 patients (median age 73, 51% male) were enrolled: Stage 0 (14.0%), Stage 1 (21.5%), Stage 2 (49.2%), Stage 3 (12.3%) and Stage 4 (3.0%). Median follow-up time was 39.5 months (IQR 22.2 to 61.0). At the end of follow-up, cumulative death was significantly higher in more advanced disease stages (log-rank p < 0.001). On multivariable analysis, Stage 3–4 was associated with increased risk of all-cause mortality (HR 3.20; 95% CI 1.48–6.93; p = 0.003). Our study suggests that extra-valvular damage is common in patients with significant AR and that a staging system developed for aortic stenosis also provides prognostic information in these patients. This staging system may be helpful for clinical decision-making regarding the time of valvular intervention.

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Funding

This study was supported by national funds through FCT Fundação para a Ciência e Tecnologia, I.P., under the scope of the Cardiovascular R&D Center—UnIC (Grant Nos. UIDB/00051/2020 and UIDP/00051/2020).

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Authors and Affiliations

  1. Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

    Gualter Silva, Pedro Queirós, Mariana Silva, José Ribeiro, Ricardo Fontes-Carvalho & Francisco Sampaio

  2. Cardiovascular Research & Development Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal

    Francisca Saraiva, António Barros, Ricardo Fontes-Carvalho & Francisco Sampaio

Authors
  1. Gualter Silva
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  2. Pedro Queirós
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  3. Mariana Silva
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  4. Francisca Saraiva
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  5. António Barros
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  6. José Ribeiro
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  7. Ricardo Fontes-Carvalho
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  8. Francisco Sampaio
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Contributions

GS and FS: conceived the present idea and developed the theory. GS, PQ and MS: performed the data collection. GS, FS and AB: performed the computations. FS and AB: verified the analytical methods and performed the analytical calculations. JR, RF-C and FS: validated the echocardiograms and supervised the findings of this work. GS, PQ, MS and FS: wrote the manuscript. All authors provided critical feedback, contributed to the interpretation of the results and approved the final manuscript.

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Correspondence to Gualter Silva.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the institution's human research committee.

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Silva, G., Queirós, P., Silva, M. et al. Staging cardiac damage in patients with aortic regurgitation. Int J Cardiovasc Imaging 38, 2645–2653 (2022). https://doi.org/10.1007/s10554-022-02673-1

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  • DOI: https://doi.org/10.1007/s10554-022-02673-1

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