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DBP, heart rate predict mortality in chronic aortic regurgitation

14 Jan 2020

Diastolic blood pressure (DBP) and resting heart rate (RHR) in patients with haemodynamically significant aortic regurgitation (AR) strongly predict all-cause mortality, independent of demographics, comorbidities, guideline-based surgical triggers, presence of hypertension and use of medications, suggests a new study.

“Therefore, DBP and RHR should be integrated into comprehensive clinical decision making for these patients,” the authors said.

From 2006 to 2017, 820 consecutive patients (mean age, 59±17 years; 82 percent men) with moderate-to-severe AR were retrospectively identified and followed for 5.5±3.5 years. Of these, 104 succumbed to death under medical management, and 400 underwent aortic valve surgery (AVS).

Age, symptoms, left ventricular ejection fraction (LVEF), LV end-systolic diameter-index (LVESDi), DBP and RHR were independently associated with all-cause mortality (p-all0.002).

After adjusting for demographics, comorbidities and surgical triggers (ie, symptoms, LVEF and LVESDi), only baseline DBP (adjusted hazard ratio [aHR] per 10-mm Hg increase, 0.79, 95 percent confidence interval [CI], 0.66–0.94; p=0.009) and baseline RHR (adjusted HR per 10 beat per min [bpm] increase, 1.23, 95 percent CI, 1.03–1.45; p=0.01) independently predicted all-cause death.

“These associations persisted after adjustment for presence of hypertension, medications, time-dependent AVS, and using average DBP and RHR (p-all≤0.02),” the authors said.

Furthermore, patients with AR, compared with the general population, demonstrated higher mortality (relative risk of death, >1), which further increased in inverse proportion (p-nonlinearity=0.002) to DBP starting at 70 mm Hg and peaking at 55 mm Hg and in direct proportion to RHR starting at 60 bpm.

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