Prognostic significance of concomitant valvular disease in moderate aortic regurgitation

AIMS: Multivalvular heart disease (MVD), defined as coexisting lesions in two or more valves, poses significant diagnostic and prognostic challenges. While isolated valvular heart disease (VHD) is well characterized, the impact of moderate aortic regurgitation (AR) with another concomitant moderate VHD remains unclear. Current guidelines focus mainly on isolated severe lesions, potentially underestimating moderate MVD. This study assessed the prevalence and prognostic impact of concomitant moderate VHD in patients with moderate AR. METHODS AND RESULTS: We retrospectively analyzed 794 patients with ≥ moderate AR (2017-2023) from a dedicated echocardiographic database. Groups were: isolated moderate AR (n = 178), isolated significant AR (n = 214), and moderate AR plus ≥ one concomitant moderate VHD (n = 402). Significant AR was defined by the presence of ≥1 echocardiographic severity criterion. Exclusion criteria included cardiomyopathy, prior cardiac surgery, LVEF <50%, or severe VHD other than AR. Follow-up was 24 months for a composite endpoint of all-cause mortality and heart failure hospitalization (HHF). VHD severity was graded per guidelines. Patients with moderate AR plus another VHD were older (79.9 vs. 66.4 years, P < 0.001), with more comorbidities and larger left atria. During follow-up, 151 patients (18.8%) met the composite endpoint (63 HHF, 108 deaths). Moderate AR with another VHD independently predicted higher risk [HR 2.83 (95% CI: 1.32-6.03; P = 0.007)], comparable to isolated significant AR [HR 2.65 (95% CI: 1.23-5.70; P = 0.013)]. CONCLUSION: Moderate AR with another concomitant moderate VHD carries a prognosis similar to significant AR, indicating this combination is not benign and may be underestimated by current guidelines.