Clinical manifestations and diagnosis of chronic aortic regurgitation in adults
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
Aortic regurgitation (AR, also called aortic insufficiency) is caused by inadequate closure of the aortic valve leaflets. It can be induced either by disease of the aortic valve leaflets or by distortion or dilation of the aortic root and ascending aorta.
This topic will review the causes, epidemiology, pathophysiology, and major clinical features of chronic AR. Issues related to course and therapy and to acute AR are discussed separately. (See "Natural history and management of chronic aortic regurgitation in adults" and "Acute aortic regurgitation in adults".)
At least trace aortic regurgitation (AR) by color Doppler echocardiography is common, even in healthy subjects. A study from the Framingham Heart Study found that, in a population-based cohort, AR of at least trace severity on color Doppler echocardiography was present in 13 percent of men and 8.5 percent of women .
The prevalence of AR varied with age and disease severity . More than trace AR was unusual before age 50 and then increased progressively.
●For mild AR, the prevalence was 3.7, 12.1, and 12.2 percent in men at ages 50 to 59, 60 to 69, and 70 to 83, respectively. The comparable values in women were 1.9, 6.0, and 14.6 percent.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999; 83:897.
- Enriquez-Sarano M, Tajik AJ. Clinical practice. Aortic regurgitation. N Engl J Med 2004; 351:1539.
- Devlin WH, Petrusha J, Briesmiester K, et al. Impact of vascular adaptation to chronic aortic regurgitation on left ventricular performance. Circulation 1999; 99:1027.
- Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the diagnosis of aortic regurgitation: what says the evidence? Ann Intern Med 2003; 138:736.
- Choudhry NK, Etchells EE. The rational clinical examination. Does this patient have aortic regurgitation? JAMA 1999; 281:2231.
- Heidenreich PA, Schnittger I, Hancock SL, Atwood JE. A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography. Clin Cardiol 2004; 27:502.
- Grayburn PA, Smith MD, Handshoe R, et al. Detection of aortic insufficiency by standard echocardiography, pulsed Doppler echocardiography, and auscultation. A comparison of accuracies. Ann Intern Med 1986; 104:599.
- Attenhofer Jost CH, Turina J, Mayer K, et al. Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med 2000; 108:614.
- Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
- Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16:777.
- Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation 2005; 112:125.
- Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33:2451.
- Gabriel RS, Renapurkar R, Bolen MA, et al. Comparison of severity of aortic regurgitation by cardiovascular magnetic resonance versus transthoracic echocardiography. Am J Cardiol 2011; 108:1014.
- Goffinet C, Kersten V, Pouleur AC, et al. Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Eur Radiol 2010; 20:326.
- Debl K, Djavidani B, Buchner S, et al. Assessment of the anatomic regurgitant orifice in aortic regurgitation: a clinical magnetic resonance imaging study. Heart 2008; 94:e8.
- CLINICAL MANIFESTATIONS
- Physical examination
- - Arterial pulse and related findings
- - Precordial examination
- - Cardiac auscultation
- Chest radiograph
- DIAGNOSIS AND EVALUATION
- When to suspect chronic aortic regurgitation
- Approach to diagnosis and evaluation
- - Findings
- Severity of AR
- Bicuspid aortic valve and aortic disease
- Cardiovascular magnetic resonance
- Invasive angiography
- DIFFERENTIAL DIAGNOSIS
- SERIAL MONITORING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS