Asymptomatic, moderate regurgitation may not warrant annual echo exam

Frequent echocardiography may not be needed for patients with asymptomatic, moderate aortic or mitral regurgitation, according to a study published online Dec. 10 in the Journal of the American College of Cardiology: Cardiovascular Imaging.

Over the course of three years, the observational study noted that among patients with asymptomatic, moderate aortic or mitral regurgitation, most appeared stable throughout. Only a small number progressed to a more severe state or developed symptoms requiring intervention.

Kenya Kusunose, MD, PhD, from the Heart and Vascular Institute at the Cleveland Clinic, and colleagues reviewed concurrent asymptomatic patient cases to develop their data set. The final cohorts consisted of 130 aortic regurgitation patients paired with 130 mitral regurgitation patients, matched by age and disease severity. All patients had yearly follow-up echocardiographs.

They found, regardless of whether the patient had mitral or aortic regurgitation, severe regurgitation progressed at a rate of left ventricular volume increase of 4.2 ml/m2 per year and decreased left ventricular ejection fraction of 1.3 percent per year. Contractility also dropped among patients with severe regurgitation over time.

No significant change in either volume, contractility, or ejection fraction was noted among patients with moderate regurgitation.

They noted that chronic regurgitation volume may be similar but incited different pathophysiology responses. Contractility was lower and left ventricular volume and mass were higher in patients with aortic regurgitations from initial patient review. Meanwhile, mitral regurgitation was characterized with enlarged, thin-walled left ventricles and a decreased mass-to-volume ratio. However, to some degree when regurgitation was moderate, these effects remained stable over the long term. Once regurgitation worsened beyond 30 ml/m2, symptoms developed leading to a progression of the disease.

They suggested continued, frequent follow-up with patients who develop symptoms, and in those with severe regurgitation. However, Kusunose et al proposed more frequent follow-up was not needed in patients with stable, moderate regurgitation and no symptoms.