While isolated severe valvular lesions are emphasized in current guidelines, the clinical implications of moderate aortic regurgitation (AR) combined with another moderate valvular heart disease (VHD) are less clearly defined.

This retrospective study published in the European Heart Journal: Cardiovascular Imaging analyzed 794 patients with ≥ moderate AR identified from an echocardiographic database between 2017 and 2023. Patients were categorized as isolated moderate AR (n=178), isolated significant AR (n=214), or moderate AR with at least one additional moderate VHD (n=402). Significant AR was defined by the presence of at least one echocardiographic severity criterion. Patients with cardiomyopathy, prior cardiac surgery, left ventricular ejection fraction <50%, or severe non-AR VHD were excluded.

Patients with moderate AR plus another VHD were older (79.9 vs 66.4 years; p<0.001), had more comorbidities, and larger left atrial size. Over 24 months, 151 patients (18.8%) experienced the composite endpoint of all-cause mortality or heart failure hospitalization (63 heart failure hospitalizations; 108 deaths).

Moderate AR with concomitant moderate VHD independently predicted increased risk (HR 2.83; 95% CI 1.32–6.03; p=0.007), comparable to isolated significant AR (HR 2.65; 95% CI 1.23–5.70; p=0.013).

In this retrospective cohort, moderate aortic regurgitation combined with another moderate valvular lesion was independently associated with increased risk of all-cause mortality or heart failure hospitalization at 24 months.