What long-term monitoring is indicated in patients with aortic regurgitation (AR)?

Updated: Nov 19, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Asymptomatic patients with severe chronic AR require ongoing clinical surveillance with periodic echocardiography. This is because significant LV dysfunction in many cases may arise even before the patient becomes symptomatic.

After the initial study, clinical evaluation and a repeat echocardiogram are recommended in 3 months. The recommended frequency of subsequent follow-up evaluations is based on the stability of the LVESD and LVEDD, as follows:

  • For patients with an end-systolic dimension (ESD) below 45 mm or an end-diastolic dimension (EDD) below 60 mm and stable dimensions, clinical evaluation is recommended every 6-12 months and repeat echocardiography is recommended every 12 months

  • For patients with an ESD below 45 mm or an EDD below 60 mm and increasing dimensions, clinical evaluation and repeat echocardiography are recommended in 3 months

  • For patients with an ESD of 45-50 mm or an EDD of 60-70 mm and stable dimensions, clinical evaluation is recommended every 6 months and repeat echocardiography is recommended every 12 months

  • For patients with an ESD of 45-50 mm or an EDD of 60-70 mm and increasing dimensions, clinical evaluation and repeat echocardiography are recommended in 3 months

  • For patients with an ESD of 50-55 mm or an EDD of 70-75 mm and stable dimensions, clinical evaluation and repeat echocardiography are recommended every 6 months

  • For patients with an ESD of 50-55 mm or an EDD of 70-75 mm and increasing dimensions, clinical evaluation and repeat echocardiography are recommended in 3 months

  • For patients with an ESD of 55 mm or greater or an EDD of 75 mm or greater, surgery is recommended

Table 1: Frequency of Followup of Patients With Aortic Regurgitation. (Open Table in a new window)

LVESD (mm)

LVEDD (mm)

Dimensions

Clinical Evaluation

Echocardiogram

< 45

< 60

Stable

6-12 months

12 months

< 45

< 60

Increasing

3 months

3 months

45-50

60-70

Stable

6 months

12 months

45-50

60-70

Increasing

3 months

3 months

50-55

70-75

Stable

6 months

6 months

50-55

70-75

Increasing

3 months

3 months

>55

>75

 

Surgery recommended


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