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Left ventricular dilatation in patients with significant aortic regurgitation: association with outcome

Pilar Lopez Santi1, Jeremy Bernard2, Federico Fortuni1,3

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2300 RC, The Netherlands.

European Heart Journal. Cardiovascular Imaging
|June 5, 2025
PubMed

Insights

Left ventricular dilatation in aortic regurgitation patients, whether linear or volumetric, independently predicts higher mortality. Combining these measures improves risk stratification for better patient outcomes.

Area of Science:

  • Cardiology
  • Echocardiography
  • Prognostic Biomarkers

Background:

  • Left ventricular (LV) dilatation is a key prognostic factor in aortic regurgitation (AR).
  • Current guidelines use LV end-systolic diameter index (LVESDi), but LV end-systolic volume index (LVESVi) may better reflect LV remodeling.
  • Improved risk stratification is needed for patients with significant AR.

Purpose of the Study:

  • To evaluate if combining LV linear and volumetric measures enhances risk stratification in AR patients.
  • To assess the prognostic value of LVESDi and LVESVi in a multi-center AR cohort.

Main Methods:

  • Multi-center study including 1070 patients with significant AR.
  • Categorization into no-significant LV dilatation, discordant LV dilatation, and concordant LV dilatation based on LVESDi and LVESVi cut-off values.
  • Primary endpoint: all-cause mortality; secondary endpoint: aortic valve surgery (AVS).

Main Results:

  • Concordant LV dilatation showed the worst 10-year survival.
  • Both discordant and concordant LV dilatation were independently associated with increased mortality compared to no significant dilatation.
  • LV dilatation independently predicted outcomes even in asymptomatic patients or those with preserved ejection fraction, and both groups benefited from AVS.

Conclusions:

  • LV dilatation, assessed by linear and/or volumetric measures, is an independent predictor of mortality in significant AR.
  • Combining LVESDi and LVESVi provides valuable prognostic information for AR patients.
  • This approach aids in risk stratification and may guide therapeutic decisions.
Abstract

Keywords:
aortic regurgitationaortic valve surgeryleft ventricular end-systolic diameter indexleft ventricular end-systolic volume indexmortalityvalvular heart disease

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