Congestive heart failure complicating aortic regurgitation with medical and surgical management: A prospective study of traditional and quantitative echocardiographic markers

Delphine Detaint, Joseph Maalouf, Christophe Tribouilloy, Douglas W. Mahoney, Hartzell V Schaff, A. Jamil Tajik, Maurice E Sarano

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: Congestive heart failure complicating aortic regurgitation is poorly described, and predictive roles of quantitative versus traditional (symptoms or low ejection fraction) surgical markers are unclear. Methods: We prospectively enrolled 287 patients with aortic regurgitation (age, 61 ± 17 years; 68% male) in whom we performed quantitative Doppler echocardiographic analysis and personal physicians conducted management. Results: After diagnosis, 40 congestive heart failure episodes occurred under medical management (10-year, 23% ± 4%) causing high subsequent mortality (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.2-6.8; P = .02). Patients with traditional surgical markers (symptoms or ejection fraction <50%) were surprisingly followed 1.4 ± 3.3 years under medical management with frequent congestive heart failure (adjusted risk, 4.9; 95% CI, 2.1-11.0; P < .001) and excess postoperative mortality (HR, 3.0; 95% CI, 1.3-7.1; P = .01). Quantitative American Society of Echocardiography aortic regurgitation grading and left ventricular end-systolic volume index independently predicted congestive heart failure (quantitative American Society of Echocardiography severe aortic regurgitation: HR, 3.6; 95% CI, 1.3-13.0; P = .015; end-systolic volume index ≥45 mL/m2: HR, 2.1; 95% CI, 1.03-4.4; P = .04) or death-congestive heart failure with incremental predictive value (P < .001). Higher congestive heart failure rates occurred with quantitative American Society of Echocardiography severe aortic regurgitation (regurgitant volume of ≥60 mL/beat or orifice of ≥30 mm2) versus quantitative American Society of Echocardiography mild aortic regurgitation (10-year: 44% ± 10% vs 15% ± 7%, P < .001) and end-systolic volume index of 45 mL/m2 or greater versus less than 45 mL/m2 (33% ± 7% vs 9% ± 2%, P < .001). Traditional markers (symptoms and ejection fraction <50%) had lower sensitivity for congestive heart failure than quantitative echocardiography (all P < .001). Cardiac surgery for aortic regurgitation markedly reduced congestive heart failure in quantitative American Society of Echocardiography severe aortic regurgitation (HR, 0.23; 95% CI, 0.08-0.68; P = .008) without excess mortality (P = .10). Conclusion: This prospective study of aortic regurgitation shows frequent congestive heart failure under conservative management. Traditional surgical markers (symptoms and ejection fraction <50%) predict subsequent congestive heart failure but are insensitive, and rescue operations are often delayed and associated with excess mortality. Quantitative echocardiography provides congestive heart failure predictors that are independent, incremental, and more sensitive than traditional markers. Cardiac surgery for aortic regurgitation markedly reduces congestive heart failure rates in high-risk patients with aortic regurgitation.

Original languageEnglish (US)
Pages (from-to)1549-1557
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume136
Issue number6
DOIs
StatePublished - Dec 2008

Fingerprint

Aortic Valve Insufficiency
Heart Failure
Prospective Studies
Confidence Intervals
Mortality
Thoracic Surgery
Echocardiography
Heart Rate
Stroke Volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Congestive heart failure complicating aortic regurgitation with medical and surgical management : A prospective study of traditional and quantitative echocardiographic markers. / Detaint, Delphine; Maalouf, Joseph; Tribouilloy, Christophe; Mahoney, Douglas W.; Schaff, Hartzell V; Tajik, A. Jamil; Sarano, Maurice E.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 136, No. 6, 12.2008, p. 1549-1557.

Research output: Contribution to journalArticle

@article{d7f4bb00e744418bb3ffad99e2930509,
title = "Congestive heart failure complicating aortic regurgitation with medical and surgical management: A prospective study of traditional and quantitative echocardiographic markers",
abstract = "Objective: Congestive heart failure complicating aortic regurgitation is poorly described, and predictive roles of quantitative versus traditional (symptoms or low ejection fraction) surgical markers are unclear. Methods: We prospectively enrolled 287 patients with aortic regurgitation (age, 61 ± 17 years; 68{\%} male) in whom we performed quantitative Doppler echocardiographic analysis and personal physicians conducted management. Results: After diagnosis, 40 congestive heart failure episodes occurred under medical management (10-year, 23{\%} ± 4{\%}) causing high subsequent mortality (hazard ratio [HR], 2.8; 95{\%} confidence interval [CI], 1.2-6.8; P = .02). Patients with traditional surgical markers (symptoms or ejection fraction <50{\%}) were surprisingly followed 1.4 ± 3.3 years under medical management with frequent congestive heart failure (adjusted risk, 4.9; 95{\%} CI, 2.1-11.0; P < .001) and excess postoperative mortality (HR, 3.0; 95{\%} CI, 1.3-7.1; P = .01). Quantitative American Society of Echocardiography aortic regurgitation grading and left ventricular end-systolic volume index independently predicted congestive heart failure (quantitative American Society of Echocardiography severe aortic regurgitation: HR, 3.6; 95{\%} CI, 1.3-13.0; P = .015; end-systolic volume index ≥45 mL/m2: HR, 2.1; 95{\%} CI, 1.03-4.4; P = .04) or death-congestive heart failure with incremental predictive value (P < .001). Higher congestive heart failure rates occurred with quantitative American Society of Echocardiography severe aortic regurgitation (regurgitant volume of ≥60 mL/beat or orifice of ≥30 mm2) versus quantitative American Society of Echocardiography mild aortic regurgitation (10-year: 44{\%} ± 10{\%} vs 15{\%} ± 7{\%}, P < .001) and end-systolic volume index of 45 mL/m2 or greater versus less than 45 mL/m2 (33{\%} ± 7{\%} vs 9{\%} ± 2{\%}, P < .001). Traditional markers (symptoms and ejection fraction <50{\%}) had lower sensitivity for congestive heart failure than quantitative echocardiography (all P < .001). Cardiac surgery for aortic regurgitation markedly reduced congestive heart failure in quantitative American Society of Echocardiography severe aortic regurgitation (HR, 0.23; 95{\%} CI, 0.08-0.68; P = .008) without excess mortality (P = .10). Conclusion: This prospective study of aortic regurgitation shows frequent congestive heart failure under conservative management. Traditional surgical markers (symptoms and ejection fraction <50{\%}) predict subsequent congestive heart failure but are insensitive, and rescue operations are often delayed and associated with excess mortality. Quantitative echocardiography provides congestive heart failure predictors that are independent, incremental, and more sensitive than traditional markers. Cardiac surgery for aortic regurgitation markedly reduces congestive heart failure rates in high-risk patients with aortic regurgitation.",
author = "Delphine Detaint and Joseph Maalouf and Christophe Tribouilloy and Mahoney, {Douglas W.} and Schaff, {Hartzell V} and Tajik, {A. Jamil} and Sarano, {Maurice E}",
year = "2008",
month = "12",
doi = "10.1016/j.jtcvs.2008.07.036",
language = "English (US)",
volume = "136",
pages = "1549--1557",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Congestive heart failure complicating aortic regurgitation with medical and surgical management

T2 - A prospective study of traditional and quantitative echocardiographic markers

AU - Detaint, Delphine

AU - Maalouf, Joseph

AU - Tribouilloy, Christophe

AU - Mahoney, Douglas W.

AU - Schaff, Hartzell V

AU - Tajik, A. Jamil

AU - Sarano, Maurice E

PY - 2008/12

Y1 - 2008/12

N2 - Objective: Congestive heart failure complicating aortic regurgitation is poorly described, and predictive roles of quantitative versus traditional (symptoms or low ejection fraction) surgical markers are unclear. Methods: We prospectively enrolled 287 patients with aortic regurgitation (age, 61 ± 17 years; 68% male) in whom we performed quantitative Doppler echocardiographic analysis and personal physicians conducted management. Results: After diagnosis, 40 congestive heart failure episodes occurred under medical management (10-year, 23% ± 4%) causing high subsequent mortality (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.2-6.8; P = .02). Patients with traditional surgical markers (symptoms or ejection fraction <50%) were surprisingly followed 1.4 ± 3.3 years under medical management with frequent congestive heart failure (adjusted risk, 4.9; 95% CI, 2.1-11.0; P < .001) and excess postoperative mortality (HR, 3.0; 95% CI, 1.3-7.1; P = .01). Quantitative American Society of Echocardiography aortic regurgitation grading and left ventricular end-systolic volume index independently predicted congestive heart failure (quantitative American Society of Echocardiography severe aortic regurgitation: HR, 3.6; 95% CI, 1.3-13.0; P = .015; end-systolic volume index ≥45 mL/m2: HR, 2.1; 95% CI, 1.03-4.4; P = .04) or death-congestive heart failure with incremental predictive value (P < .001). Higher congestive heart failure rates occurred with quantitative American Society of Echocardiography severe aortic regurgitation (regurgitant volume of ≥60 mL/beat or orifice of ≥30 mm2) versus quantitative American Society of Echocardiography mild aortic regurgitation (10-year: 44% ± 10% vs 15% ± 7%, P < .001) and end-systolic volume index of 45 mL/m2 or greater versus less than 45 mL/m2 (33% ± 7% vs 9% ± 2%, P < .001). Traditional markers (symptoms and ejection fraction <50%) had lower sensitivity for congestive heart failure than quantitative echocardiography (all P < .001). Cardiac surgery for aortic regurgitation markedly reduced congestive heart failure in quantitative American Society of Echocardiography severe aortic regurgitation (HR, 0.23; 95% CI, 0.08-0.68; P = .008) without excess mortality (P = .10). Conclusion: This prospective study of aortic regurgitation shows frequent congestive heart failure under conservative management. Traditional surgical markers (symptoms and ejection fraction <50%) predict subsequent congestive heart failure but are insensitive, and rescue operations are often delayed and associated with excess mortality. Quantitative echocardiography provides congestive heart failure predictors that are independent, incremental, and more sensitive than traditional markers. Cardiac surgery for aortic regurgitation markedly reduces congestive heart failure rates in high-risk patients with aortic regurgitation.

AB - Objective: Congestive heart failure complicating aortic regurgitation is poorly described, and predictive roles of quantitative versus traditional (symptoms or low ejection fraction) surgical markers are unclear. Methods: We prospectively enrolled 287 patients with aortic regurgitation (age, 61 ± 17 years; 68% male) in whom we performed quantitative Doppler echocardiographic analysis and personal physicians conducted management. Results: After diagnosis, 40 congestive heart failure episodes occurred under medical management (10-year, 23% ± 4%) causing high subsequent mortality (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.2-6.8; P = .02). Patients with traditional surgical markers (symptoms or ejection fraction <50%) were surprisingly followed 1.4 ± 3.3 years under medical management with frequent congestive heart failure (adjusted risk, 4.9; 95% CI, 2.1-11.0; P < .001) and excess postoperative mortality (HR, 3.0; 95% CI, 1.3-7.1; P = .01). Quantitative American Society of Echocardiography aortic regurgitation grading and left ventricular end-systolic volume index independently predicted congestive heart failure (quantitative American Society of Echocardiography severe aortic regurgitation: HR, 3.6; 95% CI, 1.3-13.0; P = .015; end-systolic volume index ≥45 mL/m2: HR, 2.1; 95% CI, 1.03-4.4; P = .04) or death-congestive heart failure with incremental predictive value (P < .001). Higher congestive heart failure rates occurred with quantitative American Society of Echocardiography severe aortic regurgitation (regurgitant volume of ≥60 mL/beat or orifice of ≥30 mm2) versus quantitative American Society of Echocardiography mild aortic regurgitation (10-year: 44% ± 10% vs 15% ± 7%, P < .001) and end-systolic volume index of 45 mL/m2 or greater versus less than 45 mL/m2 (33% ± 7% vs 9% ± 2%, P < .001). Traditional markers (symptoms and ejection fraction <50%) had lower sensitivity for congestive heart failure than quantitative echocardiography (all P < .001). Cardiac surgery for aortic regurgitation markedly reduced congestive heart failure in quantitative American Society of Echocardiography severe aortic regurgitation (HR, 0.23; 95% CI, 0.08-0.68; P = .008) without excess mortality (P = .10). Conclusion: This prospective study of aortic regurgitation shows frequent congestive heart failure under conservative management. Traditional surgical markers (symptoms and ejection fraction <50%) predict subsequent congestive heart failure but are insensitive, and rescue operations are often delayed and associated with excess mortality. Quantitative echocardiography provides congestive heart failure predictors that are independent, incremental, and more sensitive than traditional markers. Cardiac surgery for aortic regurgitation markedly reduces congestive heart failure rates in high-risk patients with aortic regurgitation.

UR - http://www.scopus.com/inward/record.url?scp=58049109176&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58049109176&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2008.07.036

DO - 10.1016/j.jtcvs.2008.07.036

M3 - Article

C2 - 19114205

AN - SCOPUS:58049109176

VL - 136

SP - 1549

EP - 1557

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -