PMID- 24874975
OWN - NLM
STAT- MEDLINE
DCOM- 20150511
LR  - 20220321
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Linking)
VI  - 27
IP  - 8
DP  - 2014 Aug
TI  - Outcomes of asymptomatic adults with combined aortic stenosis and regurgitation.
PG  - 829-37
LID - S0894-7317(14)00297-1 [pii]
LID - 10.1016/j.echo.2014.04.013 [doi]
AB  - BACKGROUND: The outcomes of patients with mixed aortic valve disease (MAVD; 
      concurrent aortic stenosis [AS] and aortic regurgitation [AR]) and its optimum 
      management are undefined. The aim of this study was to evaluate the natural 
      history of MAVD. METHODS: Between 2000 and 2005, 524 asymptomatic adults (mean 
      age, 66 +/- 14 years; 306 men) were identified who had mixed AS and AR, who did not 
      undergo early intervention with surgery. The severity of AS and AR was defined 
      using American Society of Echocardiography guideline criteria. Patients were 
      followed over 5.5 +/- 3.1 years. RESULTS: Aortic valve replacement (AVR) was 
      performed in 349 patients (67%), and 88 (17%) died. Angina, dyspnea, or syncope 
      developed in 292 patients (84%) before AVR; baseline left ventricular mass and 
      the severity of AS and AR were independent predictors of progression to AVR in 
      the overall group. Survival was associated with younger age (hazard ratio, 1.08; 
      P < .001) and valve replacement (hazard ratio, 0.61; P = .02). Most patients with 
      MAVD in the moderate category progressed to severe AS or AR by the time of 
      surgery (n = 51 [27%]); symptoms were the main indication in 22 patients. In this 
      group, AVR was associated with age, left ventricular function, valve area, and 
      the change in peak gradient over follow-up. In patients with moderate MAVD, 
      coronary artery disease was present in 38 (20%) at baseline and developed in 21 
      (21%) during follow-up but was not associated with surgery. The average time to 
      an event (AVR or death) in patients with MAVD was 4 years. CONCLUSIONS: Careful 
      surveillance of patients with MAVD is warranted, bearing in mind the composite 
      severity of both AS and AR and their combined hemodynamic effects.
CI  - Copyright (c) 2014 American Society of Echocardiography. Published by Mosby, Inc. 
      All rights reserved.
FAU - Rashedi, Nina
AU  - Rashedi N
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Popovic, Zoran B
AU  - Popovic ZB
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Stewart, William J
AU  - Stewart WJ
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Marwick, Thomas
AU  - Marwick T
AD  - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic 
      address: tom.marwick@utas.edu.au.
LA  - eng
PT  - Journal Article
DEP - 20140527
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
SB  - IM
MH  - Aged
MH  - Aortic Valve Insufficiency/complications/diagnostic imaging/*surgery
MH  - Aortic Valve Stenosis/complications/diagnostic imaging/*surgery
MH  - Disease Progression
MH  - Echocardiography, Doppler/*methods
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - Male
MH  - Prospective Studies
MH  - Transcatheter Aortic Valve Replacement/*methods
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Aortic regurgitation
OT  - Aortic stenosis
OT  - Echocardiography
OT  - Mixed disease
OT  - Surgery
OT  - Survival
OT  - Valves
EDAT- 2014/05/31 06:00
MHDA- 2015/05/12 06:00
CRDT- 2014/05/31 06:00
PHST- 2013/10/14 00:00 [received]
PHST- 2014/05/31 06:00 [entrez]
PHST- 2014/05/31 06:00 [pubmed]
PHST- 2015/05/12 06:00 [medline]
AID - S0894-7317(14)00297-1 [pii]
AID - 10.1016/j.echo.2014.04.013 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2014 Aug;27(8):829-37. doi: 10.1016/j.echo.2014.04.013. 
      Epub 2014 May 27.