Cardiac Damage Staging in Moderate or Greater Aortic Regurgitation: A New Framework for Risk Stratification.

Area of Science:

• Cardiology
• Cardiac Imaging
• Prognostics

Background:

• Cardiac damage staging is established for aortic stenosis but lacks a dedicated framework for aortic regurgitation (AR).
• Previous studies showed prognostic relevance of cardiac damage in advanced AR stages.
• A need exists for characterizing cardiac damage extent and prognostic implications in moderate or greater AR.

Purpose of the Study:

• To characterize the extent and prognostic implications of multistructural cardiac damage in patients with moderate or greater AR.
• To develop and validate a dedicated staging framework for cardiac damage in AR.
• To assess the association between cardiac damage stage and adverse cardiovascular outcomes.

Main Methods:

• Retrospective analysis of 432 adult patients with moderate or greater AR.
• Echocardiographic assessment of cardiac damage staged hierarchically from 0 to 3.
• Primary endpoint: composite of all-cause mortality and heart failure hospitalization.

Main Results:

• Advancing cardiac damage stage correlated with worsening left ventricular function, remodeling, and elevated pulmonary pressures.
• Five-year cumulative incidence of adverse outcomes significantly increased with each damage stage.
• Each stage increment was associated with a 2.1-fold higher risk of adverse outcomes (HR 2.1; 95% CI, 1.6-2.6).

Conclusions:

• Cardiac damage burden incrementally stratified long-term risk in patients with moderate or greater AR.
• A dedicated staging model for AR may refine prognostic assessment.
• This framework could support earlier aortic valve interventions.