Association of Cardiac Remodeling with Aortic Regurgitation Outcomes: The AR Consortium of the SCMR Registry

J Am Coll Cardiol. 2023 Mar 3;S0735-1097(23)04582-5. doi: 10.1016/j.jacc.2023.03.001. Online ahead of print.


Background: Quantitative cardiac magnetic resonance (CMR) outcome studies in aortic regurgitation (AR) are few. It is unclear if volume measurements are beneficial over diameters.

Objectives: To evaluate the association of CMR quantitative thresholds and outcomes in AR patients.

Methods: in a multicenter study, asymptomatic patients with moderate or severe AR on CMR with preserved LV ejection fraction (LVEF) were evaluated. Primary outcome was development of symptoms or decrease in LVEF to <50%, guideline indications for surgery based on LV dimensions, or death under medical management. Secondary outcome was the same excluding surgery for remodeling indications. We excluded patients who underwent surgery within 30 days of CMR. ROC analyses for the association with outcome were performed.

Results: We studied 458 patients, median age 60 (IQR 46-70) years. During a median follow-up of 2.4 years (IQR 0.9, 5.3), 133 events occurred. Optimal thresholds were regurgitant volume of 47 ml and regurgitant fraction of 43%, indexed LV end-systolic (iLVES) volume of 43 ml/m2, iLVED volume of 109 ml/m2, and iLVES diameter of 2 cm/m2. In multivariable regression analysis, iLVES volume ≥43 ml/m2 (HR 2.53 (1.75, 3.66), P<0.001) and and iLVED volume ≥ 109 ml/m2 were independently associated with the outcomes and provided additional discrimination improvement over iLVES diameter, whereas iLVES diameter was independently associated with the primary outcome but not the secondary outcome.

Conclusion: In asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR based LV end-systolic volume assessment performed favorably compared to LV diameters.

Keywords: aortic regurgitation; aortic valve surgery; cardiac magnetic resonance; cardiac remodeling.