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.