Cardiac Damage Staging in Moderate or Greater Aortic Regurgitation: A New Framework for Risk Stratification.

Background: Cardiac damage staging is an established prognostic tool in aortic stenosis, and an initial application to aortic regurgitation (AR) showed prognostic relevance, mainly in advanced stages. No dedicated framework currently exists for AR. We aimed to characterize the extent and prognostic implications of multistructural cardiac damage in patients with moderate or greater AR. Methods: We retrospectively analyzed 432 adult patients with ≥ moderate AR who underwent transthoracic echocardiography at Cleveland Clinic between 2008 and 2021. Cardiac damage was staged hierarchically from no damage (stage 0) to right ventricular dysfunction (stage 3) based on echocardiographic assessment of left ventricular (LV) global longitudinal strain, LV ejection fraction, chamber dimensions, valvular abnormalities, pulmonary pressures, and right ventricular function. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. Results: Over a median follow-up of 5.2 years (interquartile range, 1.9-9.3 years), advancing cardiac damage stage was associated with worsening LV function, progressive atrial and ventricular remodeling, and elevated pulmonary pressures ( Conclusions: In patients with moderate or greater AR, the burden of cardiac damage incrementally stratified long-term risk. A dedicated staging model specific to AR may refine prognostic assessment and support earlier aortic valve interventions.