Abstract

PIZARRO, Rodolfo et al. Risk Stratification in Asymptomatic Patients Severe Aortic Regurgitation: How can we Identify Patients with Adverse Outcomes?. Rev. argent. cardiol. [online]. 2007, vol.75, n.6, pp.443-449. ISSN 1850-3748.

Background Risk assessment in asymptomatic severe aortic regurgitation (AR) is not well determined yet, as there is no consensus regarding which variables should be taken into account to predict an adverse outcome. Objective To assess a score which incorporates clinical and echocardiographic variables in order to identify patients with severe AR exposed to poor outcomes. Material and Methods Two hundred and ninety four consecutive patients with asymptomatic severe AR were assessed (mean age: 63±7 years; 71% were men, left ventricle ejection fraction [LVEF]: 64%±5%). A score was developed based on the following: 1) end systolic diameter > 24 mm/m²; 2) end diastolic diameter > 36 mm/m²; 3) effective regurgitant orifice area (EROA) > 60 mm²; 4) aortic root diameter (ARD) > 45 mm; 5) age > 70 years, and 6) change from LVEF from rest to exercise (ΔFEVI) > 5%. Final end-points were: 1) long-term survival, 2) presence of symptoms during follow-up, 3) decrease in LVEF < 5%, and/ or 4) valvular surgery. Total range score: 6,5. Combined primary end-point: symptoms worsening, LVEF decrease > 5% or EF < 55% and/or death. Results During a mean follow-up of 6.7±4.2 years, 14/294 patients (4.8%) died: 5 of sudden death, 5 of congestive heart failure and 4 of extracardiac causes. During follow-up, 88 patients (30%) developed symptoms, 105 (36%) had a reduction in LVEF > 5% and 109 (37%) underwent surgery. Combined event rate (death, symptoms and/or reduction in LVEF) was 0.6%±0.1% with a score of 0-1, 37%±5% with a score of 2-3, and 73%±9% with a score > 3. The area under the ROC curve was 0.93, showing that the score discriminated well the relationship between events and risk. In turn, rate of valvular surgery was 29%±5% with a score < 2, 61%±7% with a score of 2-3, and 89%±7% with a score > 3. The ROC curve discriminated well the relationship between the score and the indication for surgery, with an area under the curve of 0.96. Conclusions In asymptomatic patients with severe aortic regurgitation, the use of a score considering clinical, echocardiographic and exercise variables allows us to make a proper identification of long-term risk.

Keywords : Regurgitation; Aortic; Prognosis; Echocardiography.

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