A novel cardiac staging system for aortic regurgitation: integrating volumetrics and strain for prognosis
S Park, Y C Kim, J Y Lee, J H Son, J H Kim, E K Kim, Chang Sa, S C Lee, S W ParkAbstract
Background
Aortic regurgitation (AR) is associated with heart failure and mortality; however, current surgical criteria primarily rely on left ventricular (LV) remodeling.
Objectives
We aimed to propose a novel cardiac stage and evaluate its prognostic value.
Methods
We retrospectively enrolled 498 patients with at least moderate AR at a single tertiary referral center between 2006 and 2022. We categorized cardiac damage into five stages (0-4), ranging from no abnormality to right-sided involvement. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, or cardiac surgery. Outcomes were compared across stages using Kaplan-Meier analysis and Cox regression.
Results
Among 498 patients with at least moderate AR over a median follow-up of 5.1 years, advancing cardiac stage was associated with a graded increase in adverse events (per-stage adjusted HR 1.55, 95% CI 1.39–1.73). Global longitudinal strain (GLS) impairment remained independently associated with outcomes (adjusted HR 1.71, 95% CI 1.28–2.27), and a significant stage-by-GLS interaction (HR 1.53; p = 0.014) indicated that the prognostic contribution of GLS was greatest at earlier stages and diminished with advancing stage.
Conclusion
A novel cardiac staging system effectively stratifies risk in significant AR. Higher stages were associated with progressively worse outcomes. Impaired LV GLS provided its greatest prognostic value in the early stages, supporting its use for clinical risk assessment and optimal surgical timingPrimary outcome by cardiac staging of AR