ArticleJACC. Cardiovascular imaging2025
Staging of Cardiac Adverse Remodeling in Moderate or Severe Aortic Regurgitation.
Article in JACC. Cardiovascular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04281823 (Houston Methodist DeBakey Cardiovascular Magnetic Resonance Study), which is not on this map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Houston Methodist DeBakey Cardiovascular Magnetic Resonance Study
Who cites it
2 citing papers in PubMed.
- Myocardial remodeling in valvular heart disease: pathophysiology, multimodality imaging and treatment implications.Heart failure reviews · 2026Review
- The Added Value of 4D-Flow CMR: Identifying Aortic Regurgitation as the Culprit for Severe Cardiomyopathy.Clinical case reports · 2026Article
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Authors and funding
11 authors.
Funding
Abstract
backgroundA recently proposed staging system for cardiac structural and functional abnormalities demonstrated incremental prognostic value in aortic stenosis.
objectivesThe authors investigate a staging system incorporating cardiac magnetic resonance (CMR) in moderate or severe aortic regurgitation (AR).
methodsPatients prospectively enrolled in DEBAKEY-CMR (DeBakey Cardiovascular Magnetic Resonance Study; NCT04281823) between 2009 and 2020 who had moderate or severe AR by CMR were studied. We excluded patients with a primary cardiomyopathy (eg, hypertrophic cardiomyopathy, amyloidosis, sarcoidosis) or prior valve intervention. The stages were defined as stage 0: no cardiac remodeling; stage 1: left ventricular (LV) remodeling; stage 2: mitral valve or left atrial abnormalities; and stage 3: right heart remodeling. The outcome was all-cause mortality.
resultsThe authors studied 395 patients, median age 62 years (Q1-Q3: 51-72 years); 79.2% were male, and 25.8% had bicuspid aortic valve. Thirty-two patients (8.10%) were classified as stage 0, 146 (37.0%) as stage 1, 77 (19.5%) as stage 2, and 140 (35.4%) as stage 3. Over a mean follow-up period of 3.9 ± 2.9 years, the annualized mortality rate was 0.68% per year in stage 0, 2.25% per year in stage 1, 3.76% per year in stage 2, and 7.25% per year in stage 3 (P for trend of mortality <0.001). The extent of cardiac remodeling was independently associated with increased hazard for mortality (adjusted HR: 1.69 per increment of stage [95% CI: 1.28-2.23]; P < 0.001) after adjusting for regurgitation severity, aortic valve replacement (AVR), and EuroSCORE II (European System for Cardiac Operative Risk Evaluation). Patients with right heart remodeling had the highest hazard for events.
conclusionsA cardiac remodeling staging system incorporating CMR findings provides incremental prognostication in AR after adjusting for surgical risk, AVR, and regurgitation severity. Right heart remodeling in AR was associated with the highest mortality. Further research can determine whether the staging system could aid in guiding patient management and the timing of intervention.
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