Prognostic implications of moderate aortic stenosis with concomitant aortic regurgitation in degenerative aortic valve disease: insights from a multicentre cohort

Mixed aortic valve disease poses unique haemodynamic challenges. This study compared the clinical outcomes of concomitant moderate aortic stenosis (AS) and moderate aortic regurgitation to isolated AS.

We analysed a multicentre cohort of valvular heart disease between 2008 and 2022 at three tertiary centres. The entire cohort was divided into three groups: moderate AS accompanied by moderate aortic regurgitation (moderate ASR), isolated severe AS, and isolated moderate AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. The final analysis included 4395 patients (median age: 76 years, 50.8% male), comprising 224 patients with moderate ASR, 1996 with severe AS, and 2175 with moderate AS. Over a median follow-up of 3.4 years, aortic valve replacement (AVR) rates were 11.1, 57.2, and 7.8 per 100 person-years in the moderate ASR, severe AS, and moderate AS groups, respectively (P < 0.001). Patients with moderate ASR had a significantly higher risk of the primary outcome compared with moderate AS [adjusted hazard ratio (aHR) 1.49; 95% confidence interval (CI) 1.15–1.92; P = 0.002] and a risk comparable to severe AS (aHR 1.28; 95% CI 1.00–1.64; P = 0.052). These results remained consistent even when AVR was included as a time-varying covariate. Older age, male sex, renal dysfunction, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with moderate ASR.

Moderate ASR should not be considered a benign condition, as it is associated with poor clinical outcomes comparable to those of severe AS.