Aortic insufficiency natural history


 * Associate Editor-in-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Overview
In acute aortic insufficiency symptoms of heart failure often develop acutely. Chronic aortic insufficiency is usually insidious and progressive and the patient may remain asymptomatic for years. Once left ventricular dilation and left ventricular failure occurs, dyspnea on exertion and exercise intolerance begins to occur. Later symptoms such as angina, syncope, and other symptoms of heart failure are present.

Acute Aortic Insufficiency
In acute aortic insufficiency symptoms of heart failure such as pulmonary edema often develop acutely.

Chronic Aortic Insufficiency
Chronic aortic insufficiency is usually insidious and progressive and the patient may remain asymptomatic for years. Once left ventricular dilation and left ventricular failure occurs, dyspnea on exertion and exercise intolerance begins to occur. Later symptoms such as angina, syncope, and other symptoms of heart failure are present.

Acute Aortic Insufficiency

 * 1) Left ventricular volume overload in a non-compliant left ventricle with acute left ventricular failure
 * 2) Pulmnary edema
 * 3) Sudden cardiac death

Chronic Aortic Insufficiency

 * 1) Heart failure
 * 2) Arrhythmia
 * 3) Myocardial ischemia
 * 4) Aortic dissection in patients with bicuspid aortic valve
 * 5) Infective endocarditis

Prognosis
The prognosis and survival of patients with symptomatic aortic regurgitation has improved significantly over the last decade. The five year survival rate for symptomatic patients is now more than 80 percent.

Acute Aortic Insufficiency
The prognosis among patients with aortic insufficiency is poor with a high mortality and morbidity due to the acute onset of left ventricular failure, pulmonary edema, myocardial ischemia due to the abrupt rise in LV wall stress and sudden cardiac death. Early surgical intervention improves the prognosis in these patients.

Asymptomatic Patients

 * Mortality rate - 2.8% per year

Asymptomatic Patients with Normal Ejection Fraction

 * Rate of progression to symptoms or left ventricular dysfunction ≤ 6% per year
 * Rate of progression to asymptomatic left ventricular dysfunction ≤ 3.5% per year
 * Rate of sudden death ≤ 0.2% per year

Asymptomatic Patients with Reduced Ejection Fraction

 * Rate of progression to symptoms ≥ 25% per year

Symptomatic patients

 * Mortality rate ≥ 10% per year

Symptomatic Patients

 * NYHA class I - 3.0% per year
 * NYHA class II - 6.3% per year
 * NYHA class III-IV - 24.6% per year

====Patients with Chronic Severe Aortic Insufficiency who are Managed Conservatively ====
 * Death from any cause - 4.7% per year
 * Congestive heart failure - 6.2% per year
 * Aortic valve surgery - 14.6% per year