Natural history of patients with aortic
regurgitation
Studies of patient survival have shown that aortic regurgitation (AR)
has a less benign course than once believed. In early series, the
mortality rate was reported to be ~0.2% annually.
However, this was due to inadequate follow-up of the patients and this
has increased to 2.2% per year based on recent studies with meticulous
follow-up1 – 3. An elaborate study from the Cleveland
Clinic reported that 29% of patients with grade III or greater AR and
preserved left ventricular ejection fraction (LVEF) died without aortic
valve surgery during a mean follow-up of 6.6 ± 3 years, whereas only
13% died following aortic valve surgery, which seemed similar to the
survival of the age- and sex-matched population in the USA (Fig.
1)3. Other drawbacks of previous studies were low
mortality rates of young patients which seemed unlikely in general
clinical practice or lack of standardized assessment of AR severity.
Another study from the Mayo clinic employed quantitative American
Society of Echocardiography thresholds for AR grading4and followed up the long-term prognosis of asymptomatic patients with
LVEF ≥ 50% and an average age of 60 years. They found that 10-year
survival of overall patients and those aged 50 or more with severe AR
was 69% and 59%, respectively2.