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Prevalence and relevance of impaired left ventricular function in chronic moderate regurgitation of native aortic

Bruna Gomes1, Katharina Hees2, Hauke Hund1

  • 1Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.

Acta Cardiologica
|July 18, 2019
PubMed

Insights

Most patients with moderate aortic regurgitation (AR) maintain normal ejection fraction (EF). However, some develop reduced EF, particularly with renal insufficiency or atrial fibrillation, indicating potential cardiomyopathy.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure

Background:

  • Chronic moderate aortic regurgitation (AR) can lead to reduced left ventricular (LV) ejection fraction (EF), potentially due to late remodeling or a specific cardiomyopathy (CMP) phenotype.
  • Distinguishing between these causes is crucial for understanding disease progression.

Purpose of the Study:

  • To analyze the progression of left ventricular (LV) impairment in patients with chronic moderate aortic regurgitation (AR).
  • To identify factors associated with worsening LV function in this patient cohort.

Main Methods:

  • Retrospective analysis of 152 patients with pure chronic moderate AR identified from an echocardiography database (2005-2016).
  • Exclusion of patients with significant coronary artery disease or other valve disease.
  • Patients categorized into three groups: preserved LV systolic function, reduced EF with pre-existing CMP, and reduced EF without pre-existing CMP.

Main Results:

  • The majority of patients (66%) had preserved LV systolic function and stable LV end-diastolic diameter (LVEDD).
  • A subset of patients (18%) without pre-existing CMP showed reduced EF at baseline and increased LVEDD over time; these patients were significantly older.
  • Renal insufficiency, atrial fibrillation, and NYHA class > II were identified as significant risk factors for worsening LV function.

Conclusions:

  • Preserved LV EF and LVEDD are generally stable in most patients with chronic moderate AR over extended periods.
  • A subset of patients may develop reduced LV EF even without AR progression to severe, especially when comorbidities like renal insufficiency or atrial fibrillation are present.
  • These findings highlight the importance of monitoring LV function and associated risk factors in moderate AR.

Keywords:
Moderate aortic regurgitationaortic valve replacementcardiomyopathyimpaired left ventricular function

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