Doppler Echocardiographic Assessment of Progression of Aortic Regurgitation

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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.

Section snippets

Patient Population

A total of 127 consecutive patients with AR studied by 2-dimensional echocardiography and Doppler color flow mapping in our laboratory since 1988 were included. Patients ≥14 years old with AR who had ≥2 echocardiographic studies with a follow-up ≥6 months were selected. Patients with trace AR,[6]aortic gradient >20 mm Hg, aortic valve replacement after a short follow-up (<6 months), mitral prosthesis, mitral regurgitation (more than mild), congenital heart disease (except bicuspid aortic

Patient Characteristics at Entry

A total of 127 patients were studied (69 men; 59 ± 21 years; range 14 to 94). The follow-up interval was 21 ± 11 months (range 6 to 47) and was similar in patients with mild, moderate, and severe AR (20 ± 12, 21 ± 11, and 23 ± 11 months, respectively). Bicuspid aortic valves were diagnosed in 21 patients and rheumatic heart disease in 10; otherwise, etiologic diagnosis was not evident. Fig. 1 displays the number of patients in each branch of the AR grade algorithm. Since the subsets of patients

Discussion

This study reports on the largest number of patients to date with chronic AR followed by 2-dimensional echocardiography, and is the first to analyze the progression of AR by color Doppler. It provides: (1) the rate of progression of regurgitation; (2) differences in LV size and function among patients with different degrees of AR; (3) changes in LV size and function during the follow-up in patients with the various degrees of AR; and (4) determinants of progression.

Acknowledgements

Luis R. Padial, MD, was a visiting Clinical and Research Fellow from the “Hospital Virgen de la Salud,” Toledo, Spain, supported by a grant from the “Fondo de Investigación Sanitaria” of the Ministry of Health of Spain, Madrid, Spain.

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