Outcomes of degenerative aortic valve regurgitation: a single center study

    Authors

    Keywords

    aortic regurgitation, degenerative aortic valve disease, aortic valve replacement

    DOI

    https://doi.org/10.15836/ccar2025.101

    Full Text

    **Introduction:** Aortic regurgitation (AR) contributes to left ventricle (LV) eccentric remodeling due to both volume and pressure overload and. Etiological causes are multiple, but the most common cause of AR today is idiopathic degeneration with loss of elastin and collagen fibers. (1, 2) The aim of this study was to evaluate if degenerative etiology of AR contributes to worse outcomes in patients treated for significant AR. **Methods:** Our overall study population (SP) consisted of 123 patients with significant AR due to any cause. All patients were treated in University Hospital Centre Zagreb from 2017-2019 according to guidelines. Further on, a subpopulation of patients with degenerative aortic valve regurgitation (dAR) was analyzed using the same outcome parameters in order to compare mixed etiology (endocarditis, leaflet restriction, rheumatic disease, ascending aorta dilatation) of AR with dAV and highlight the impact of valve degeneration on outcomes. Study population characteristics are shown in **Table 1**. Outcomes included the change in LV end-diastolic volume (ΔEDV, ml), end-systolic volume (ΔESV, ml), ejection fraction (EF, %), myocardial mass (ΔLVMI, g/m2), MACE and mortality in a mean follow up time of 57 months. ### TABLE 1: Characteristics of the overall study population and the degenerative aortic regurgitation subgroup. | | **SP** | **SP** | **dAR** | **dAR** | | --- | --- | --- | --- | --- | | **N** | 123 | | 47 | | | **Age** | 58.7 | | 60.2 | | | **FU (months)** | 75 | | 57.4 | | | **Severe AR** | 80 | 65% | 35 | 74.50% | | **Moderate AR** | 35 | 28.40% | 12 | 25.50% | | **Mortality** | 16 | 13% | 8 | 17% | | **Male** | 99 | 81% | 38 | 80.80% | | **Female** | 24 | 19.50% | 9 | 19.20% | | **No coronary disease** | 89 | 72% | 34 | 72.30% | | **Mechanical AV** | 40 | 32.50% | 12 | 25.50% | | **Biologic AV** | 19 | 15.40% | 6 | 12.70% | | **Reconstructed AV** | 9 | 7.30% | 6 | 12.70% | | **CON** | 55 | 44.70% | 23 | 48.90% | | **AS** | 15 | 12.20% | 12 | 25.50% | [†] N-number of study population, AR-aortic regurgitation, FU-follow up, AV-aortic valve, CON-conservative treatment, AS-aortic stenosis **Results:** Both groups were comparable in age, sex and presence of coronary artery disease. In group dAR patients had more sever AR (65% in SP vs 74.5% in dAR) and more frequently accompanied aortic stenosis (12.2% vs 25.5%), **Table 2**. Patients with dAR had higher EDV at the point of diagnosis and in follow up, but more pronounced reduction in ESV with a tendency for recovery of EF and reduction in LVMI compared to SP. The dAR group showed tendency for less hospitalizations and MACE but higher incidence in mortality. ### TABLE 2: Change in echocardiographic parameters and clinical outcomes between the overall study population and the degenerative aortic regurgitation subgroup. | | **SP** | **SP** | **Δ** | **dAR** | **dAR** | **Δ** | | --- | --- | --- | --- | --- | --- | --- | | **EDV** | 187.4 | 151.9 | 35.5 | 201.0 | 164.6 | 36.4 | | **ESV** | 94.7 | 79.9 | 14.8 | 102.6 | 81.6 | 21.0 | | **EF** | 54.1 | 51.9 | 2.1 | 53.0 | 54.9 | -1.9 | | **LVMI** | 184.9 | 163.6 | 21.3 | 201.4 | 175.6 | 25.8 | | **MACE** | | 30 | 24.4% | | 10 | 21% | | **HOSP** | | 32 | 26% | | 8 | 17% | | **Mortality** | | 16 | 13% | | 8 | 17% | [†] End-diastolic volume-EDV, end-systolic volume-ESV, ejection fraction-EF, left ventricular mass index-LVMI, MACE- major adverse cardiovascular events, HOSP-number of hospitalizations, SP-overall study population, dAR-degenerative aortic- regurgitation, Δ- difference between primary values and in follow up **Conclusion:** Degenerative AR tends to be diagnosed and treated with delay, with more severe AR, accompanied AS and higher mortality rate compared to other etiological factors of AR.

    Literature

    1. Lakier JB, Copans H, Rosman HS, Lam R, Fine G, Khaja F, et al. Idiopathic degeneration of the aortic valve: a common cause of isolated aortic regurgitation. J Am Coll Cardiol. 1985 February;5(2 Pt 1):347–57. https://doi.org/10.1016/S0735-1097(85)80057-7
    2. Li G, Li T, Chen Y, Guo X, Li Z, Zhou Y, et al. Associations between aortic regurgitation severity and risk of incident myocardial infarction and stroke among patients with degenerative aortic valve disease: insights from a large Chinese population-based cohort study. BMJ Open. 2021 August 26;11(8):e046824. https://doi.org/10.1136/bmjopen-2020-046824
    Cardiologia Croatica
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    Outcomes of degenerative aortic valve regurgitation: a single center study

    Extended Abstract
    Issue5-6
    Published
    Pages101-102
    PDF via DOIhttps://doi.org/10.15836/ccar2025.101
    aortic regurgitation
    degenerative aortic valve disease
    aortic valve replacement

    Authors

    Marija Brestovac*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Sandra Jakšić JurinjakORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Martina Lovrić BenčićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    *Correspondence email: marija.brestovac@gmail.com

    Full Text

    Introduction: Aortic regurgitation (AR) contributes to left ventricle (LV) eccentric remodeling due to both volume and pressure overload and. Etiological causes are multiple, but the most common cause of AR today is idiopathic degeneration with loss of elastin and collagen fibers. (1, 2) The aim of this study was to evaluate if degenerative etiology of AR contributes to worse outcomes in patients treated for significant AR.

    Methods: Our overall study population (SP) consisted of 123 patients with significant AR due to any cause. All patients were treated in University Hospital Centre Zagreb from 2017-2019 according to guidelines. Further on, a subpopulation of patients with degenerative aortic valve regurgitation (dAR) was analyzed using the same outcome parameters in order to compare mixed etiology (endocarditis, leaflet restriction, rheumatic disease, ascending aorta dilatation) of AR with dAV and highlight the impact of valve degeneration on outcomes. Study population characteristics are shown in Table 1. Outcomes included the change in LV end-diastolic volume (ΔEDV, ml), end-systolic volume (ΔESV, ml), ejection fraction (EF, %), myocardial mass (ΔLVMI, g/m2), MACE and mortality in a mean follow up time of 57 months.

    TABLE 1: Characteristics of the overall study population and the degenerative aortic regurgitation subgroup.

    N
    SP
    123
    dAR
    47
    Age
    SP
    58.7
    dAR
    60.2
    FU (months)
    SP
    75
    dAR
    57.4
    Severe AR
    SP
    80
    SP
    65%
    dAR
    35
    dAR
    74.50%
    Moderate AR
    SP
    35
    SP
    28.40%
    dAR
    12
    dAR
    25.50%
    Mortality
    SP
    16
    SP
    13%
    dAR
    8
    dAR
    17%
    Male
    SP
    99
    SP
    81%
    dAR
    38
    dAR
    80.80%
    Female
    SP
    24
    SP
    19.50%
    dAR
    9
    dAR
    19.20%
    No coronary disease
    SP
    89
    SP
    72%
    dAR
    34
    dAR
    72.30%
    Mechanical AV
    SP
    40
    SP
    32.50%
    dAR
    12
    dAR
    25.50%
    Biologic AV
    SP
    19
    SP
    15.40%
    dAR
    6
    dAR
    12.70%
    Reconstructed AV
    SP
    9
    SP
    7.30%
    dAR
    6
    dAR
    12.70%
    CON
    SP
    55
    SP
    44.70%
    dAR
    23
    dAR
    48.90%
    AS
    SP
    15
    SP
    12.20%
    dAR
    12
    dAR
    25.50%

    N-number of study population, AR-aortic regurgitation, FU-follow up, AV-aortic valve, CON-conservative treatment, AS-aortic stenosis

    Results: Both groups were comparable in age, sex and presence of coronary artery disease. In group dAR patients had more sever AR (65% in SP vs 74.5% in dAR) and more frequently accompanied aortic stenosis (12.2% vs 25.5%), Table 2. Patients with dAR had higher EDV at the point of diagnosis and in follow up, but more pronounced reduction in ESV with a tendency for recovery of EF and reduction in LVMI compared to SP. The dAR group showed tendency for less hospitalizations and MACE but higher incidence in mortality.

    TABLE 2: Change in echocardiographic parameters and clinical outcomes between the overall study population and the degenerative aortic regurgitation subgroup.

    EDV
    SP
    187.4
    SP
    151.9
    Δ
    35.5
    dAR
    201.0
    dAR
    164.6
    Δ
    36.4
    ESV
    SP
    94.7
    SP
    79.9
    Δ
    14.8
    dAR
    102.6
    dAR
    81.6
    Δ
    21.0
    EF
    SP
    54.1
    SP
    51.9
    Δ
    2.1
    dAR
    53.0
    dAR
    54.9
    Δ
    -1.9
    LVMI
    SP
    184.9
    SP
    163.6
    Δ
    21.3
    dAR
    201.4
    dAR
    175.6
    Δ
    25.8
    MACE
    SP
    30
    Δ
    24.4%
    dAR
    10
    Δ
    21%
    HOSP
    SP
    32
    Δ
    26%
    dAR
    8
    Δ
    17%
    Mortality
    SP
    16
    Δ
    13%
    dAR
    8
    Δ
    17%

    End-diastolic volume-EDV, end-systolic volume-ESV, ejection fraction-EF, left ventricular mass index-LVMI, MACE- major adverse cardiovascular events, HOSP-number of hospitalizations, SP-overall study population, dAR-degenerative aortic- regurgitation, Δ- difference between primary values and in follow up

    Conclusion: Degenerative AR tends to be diagnosed and treated with delay, with more severe AR, accompanied AS and higher mortality rate compared to other etiological factors of AR.

    Literature

    1. 1.
      Lakier JB, Copans H, Rosman HS, Lam R, Fine G, Khaja F, et al. Idiopathic degeneration of the aortic valve: a common cause of isolated aortic regurgitation. J Am Coll Cardiol. 1985 February;5(2 Pt 1):347–57.DOI
    2. 2.
      Li G, Li T, Chen Y, Guo X, Li Z, Zhou Y, et al. Associations between aortic regurgitation severity and risk of incident myocardial infarction and stroke among patients with degenerative aortic valve disease: insights from a large Chinese population-based cohort study. BMJ Open. 2021 August 26;11(8):e046824.DOI