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

Francisco B Alexandrino1, Ian Persits1, Joseph Hajj2

  • 1Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.

Structural Heart : the Journal of the Heart Team
|December 11, 2025
PubMed

Insights

Cardiac damage staging in aortic regurgitation (AR) predicts long-term risk. A new staging model for AR may improve prognostic assessment and guide earlier interventions for patients with moderate or greater AR.

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.
Abstract

Keywords:
Aortic regurgitationAortic valve replacementCardiac damageGlobal longitudinal strainStaging

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