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Doppler echocardiographic assessment of progression of aortic regurgitation
L R Padial1, A Oliver, M Vivaldi
1Department of Cardiology, Massachusetts General Hospital, Boston 02114, USA.
Insights
Chronic aortic regurgitation (AR) progresses even in mild and moderate cases. More severe AR leads to faster left ventricular dilation, a key finding for understanding AR progression.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- The progression rate of chronic aortic regurgitation (AR) is not well-established.
- Left ventricular (LV) dilation in severe AR is known, but its rate and relation to AR severity, especially in mild/moderate AR, remain unclear.
Purpose of the Study:
- To investigate the progression of chronic AR using echocardiography.
- To examine the relationship between LV dilation and the severity/progression of AR across all severity levels.
Main Methods:
- Two-dimensional and Doppler echocardiography were used to study 127 patients with varying degrees of AR.
- Patient data included AR severity, LV volumes, LV mass, and follow-up assessments.
Main Results:
- AR progressed in 30% of patients, with higher rates in moderate and severe AR.
- LV volumes and mass increased significantly during follow-up, with faster increases in patients with more severe or rapidly progressing AR.
- Bicuspid aortic valves were associated with a higher prevalence of severe AR.
Conclusions:
- Chronic aortic regurgitation is a progressive condition, even in mild and moderate stages.
- Left ventricular dilation is directly related to AR severity and progresses more rapidly in more severe cases.
Abstract:
The rate of progression of the degree of chronic aortic regurgitation (AR) is unknown. Furthermore, although left ventricular (LV) dilation has been studied in patients with severe AR, its rate and determining factors, and specifically, its relation to the degree of regurgitation remain to be established and have not previously been studied for mild and moderate AR. The purpose of this study was to explore the progression of chronic AR by 2-dimensional and Doppler echocardiography, and the relation of LV dilation to the fundamental regurgitant lesion and its progression in patients with a full spectrum of initial AR severity. We studied 127 patients with AR by 2-dimensional and Doppler echocardiography (69 men; 59 +/- 21 years; 67 with mild, 45 with moderate, 15 with severe AR). AR increased in 38 patients (30%) (25% of mild, 44% of moderate, and 50% of moderate to severe lesions; p <0.006). The ratio of proximal AR jet height to LV outflow tract height also increased (30.3 +/- 17.5% vs 35.2 +/- 19.7%; p <0.0001). Initial LV volumes and mass were larger in patients with more severe AR and increased significantly during follow-up (138 +/- 53 to 164 +/- 70 ml; 59 +/- 32 to 71.7 +/- 42 ml; 203 +/- 89 to 241 +/- 114 g; p <0.0001). LV volumes and mass increased faster in patients with more severe AR, and in those in whom the degree of AR progressed more rapidly. Finally, patients with bicuspid aortic valve (n = 21) had a higher prevalence of severe AR than patients with tricuspid aortic valves (52% vs 4%; p <0.001). In conclusion, AR is a progressive disease not only in patients with severe AR but also in those with mild and moderate regurgitation. Patients with more severe AR have larger left ventricles that also dilate more rapidly.