Systolic aortic regurgitation. A new prognostic marker in heart failure patients?

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction

OBJECTIVE:

Systolic aortic regurgitation (SAR) is considered to be a specific sign of heart failure (HF). However, the prevalence and importance of SAR in patients with HF and preserved ejection fraction (HFpEF) are unknown. Therefore, we sought to examine the prevalence of SAR in HFpEF outpatients and its association with all-cause mortality and/or cardiovascular hospitalizations during a 1-year follow-up.

METHODS:

We enrolled 301 consecutive outpatients with HFpEF (mean age of 67.3±9.6 years, 53.5% women) and prospectively followed up for one year. Demographic, clinical, echocardiographic, and laboratory data were obtained at study entry. The composite endpoint of this study was all-cause mortality or HF-related hospitalizations in one year.

RESULTS:

SAR was noted in 30 (9.9%) of the patients, and 38 patients (12.6%) reached the primary endpoint. The primary composite endpoint in one year was higher for the patients with SAR (26.3%) compared to the patients without SAR (7.6%, p<0.001). After adjusting for important covariates, SAR remained independently associated with primary outcome (OR 2.315; 95% CI 1.188–5.477; p=0.008).

CONCLUSION:

To our knowledge, this is the first study to demonstrate that the presence of SAR is associated with adverse events in patients with HFpEF.

Isolated myxoid degeneration of aortic valve: diagnostic dilemma

Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.