Heart Podcast The natural history of aortic regurgitation
Apr 7, 2026
Dr Jwan Naser, Cardiology fellow at the Mayo Clinic and valvular disease researcher, discusses asymptomatic moderate–severe aortic regurgitation. She covers the condition’s natural history, age-related mortality differences, debates around early surgery versus conservative care, limits of ejection fraction as a trigger for intervention, and the search for more sensitive imaging markers.
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Asymptomatic Aortic Regurgitation Is Not Benign
- Asymptomatic moderate or severe aortic regurgitation (AR) carries measurable long-term risk rather than being benign.
- Meta-analysis included 27 observational cohorts (1973–2025) with 4,720 patients and ~4 years mean follow-up under conservative management.
Historical Cohorts Underestimate Contemporary Risk
- Older AR cohorts were younger, prospective, and reported lower adverse events; modern cohorts show higher risks and older patients.
- Pre-2000 mean age ~36 with lower events vs post-2000 mean age ~53 and much higher event rates.
Mortality Risk Varies Strongly With Patient Age
- Pooled all-cause mortality on conservative management was 1.75% per year overall, varying strongly with cohort age.
- Younger cohorts (mean ~37 years) had 0.6%/yr, older cohorts (mean ~56 years) had 2.6%/yr, both ~2× population expectation.