From the Guidelines
For mild-to-moderate aortic regurgitation in a 65-year-old with normal ejection fraction and minimal symptoms, echocardiographic monitoring should be performed every 2 years, with clinical evaluation and history and physical examination occurring annually. The echocardiogram should assess left ventricular size and function, severity of regurgitation, and aortic root dimensions. This recommendation is based on the guidelines from the European Heart Journal 1, which suggest that patients with mild-to-moderate AR can be reviewed on a yearly basis and echocardiography performed every 2 years.
Key Considerations
- Aortic regurgitation does not always progress in severity; the rate of progression varies considerably between individuals, with factors such as etiology of the regurgitation, blood pressure control, and presence of aortic dilation influencing progression 1.
- Approximately 4-6% of patients with initially mild-to-moderate regurgitation progress to severe regurgitation annually.
- The patient should be educated about symptoms that warrant prompt medical attention, including increasing shortness of breath, decreased exercise tolerance, chest pain, or syncope, as these may indicate disease progression requiring intervention.
- If the condition is stable, the recommended interval is appropriate, but more frequent monitoring (every 6-12 months) is recommended if there are changes in symptoms or signs of progression 1.
- No specific medications are required for asymptomatic patients with preserved left ventricular function, though standard cardiovascular risk factor management is important.
Monitoring and Follow-up
- Clinical evaluation with history and physical examination should occur annually to monitor for changes in symptoms and signs of progression.
- Echocardiography should be performed every 2 years to assess left ventricular size and function, severity of regurgitation, and aortic root dimensions.
- More frequent monitoring may be necessary if there are changes in symptoms or signs of progression, or if the patient has a dilated aorta or other high-risk features 1.
From the Research
Frequency and Interval Investigations
- For a 65-year-old patient with mild-to-moderate aortic regurgitation, normal ejection fraction, and minimal symptoms, the frequency and interval of investigations should be based on the severity of the regurgitation and the presence of symptoms 2, 3.
- Echocardiography is the primary method for determining the etiology and severity of aortic regurgitation, and it should be performed regularly to monitor the progression of the disease 2, 4.
- The interval between investigations may vary depending on the severity of the regurgitation and the presence of symptoms, but it is generally recommended to perform echocardiography at least annually for patients with mild-to-moderate aortic regurgitation 3.
Progression of Aortic Regurgitation
- Aortic regurgitation does not always progress in severity, and the rate of progression can vary significantly between patients 3.
- Factors such as the etiology of the regurgitation, the presence of symptoms, and the left ventricular function can influence the progression of the disease 3, 5.
- Regular monitoring with echocardiography and other imaging modalities can help identify patients who are at risk of progression and allow for timely intervention 2, 4.
- Asymptomatic patients with severe aortic regurgitation and preserved left ventricular function may benefit from vasodilator drug therapy to reduce the severity of the regurgitation 3.