Patients are stratified according to quantitative American Society of Echocardiography (QASE) aortic regurgitation (AR) grading. The QASE-severe AR is defined as regurgitant volume 60 ml/beat or effective regurgitant orifice (ERO) 30 mm² (yellow line), QASE-mild AR as regurgitant volume <30 ml/beat and ERO <10 mm² (brown line), and QASE-moderate AR (dotted orange line) as larger than mild (regurgitant volume 30 ml/beat or ERO 10 mm²), but not reaching QASE-severe criteria. The 5- and 10-year survival rates ± SE are indicated. Note the lower survival with QASE-severe AR, whereas QASE-moderate AR displays survival similar to QASE-mild AR up to 5 years after diagnosis, with higher mortality thereafter.

Patients are stratified according to QASE AR grading. The QASE-severe AR is defined as regurgitant volume 60 ml/beat or ERO 30 mm² (yellow line). The QASE-mild AR as regurgitant volume <30 ml/beat and ERO <10 mm² (brown line), and QASE-moderate AR (dotted orange line) as larger than mild (regurgitant volume 30 ml/beat or ERO 10 mm²), but not reaching QASE-severe criteria. The 5- and 10-year rates of the end point ± SE are indicated. Note the wide difference in outcome according to QASE grading at baseline. AVR = aortic valve replacement; other abbreviations as in Figure 1.

Patients are stratified according to QASE AR grading. The QASE-severe AR is defined as regurgitant volume 60 ml/beat or ERO 30 mm² (yellow line), QASE-mild AR as regurgitant volume <30 ml/beat and ERO <10 mm² (brown line), and QASE-moderate AR (dotted orange line) as larger than mild (regurgitant volume 30 ml/beat or ERO 10 mm²), but not reaching QASE-severe criteria. The 5- and 10-year event rates ± SE are indicated. Note the progressive increase in event rates with the severity of QASE-grading of AR. Abbreviations as in Figure 1.

Cardiac events (cardiac death, congestive heart failure, and new atrial fibrillation) under conservative management after diagnosis of asymptomatic AR according to the left ventricular end-systolic volume index (ESVI, <45 ml/m² [dotted line] or 45 ml/m² [solid line]) stratified by quantitative AR grading. The left graph indicates cardiac events in patients with QASE-mild or QASE-moderate AR grades. The right graph indicates rates in QASE-severe AR grade. Note the higher cardiac events rates (indicated at 5 and 10 years ± SE) with ESVI 45 ml/m², particularly with QASE-severe AR. Abbreviations as in Figure 1.

In each panel, survival or event rates are indicated at 5 and 10 years ± SE. Note the low mortality in patients age <50 years (A, 10-year survival 100%, 91 ± 9%, and 100% in QASE-mild, QASE-moderate, and QASE-severe, respectively), whereas mortality is higher after age 50 years (C) and significantly related to QASE-grading of AR. Cardiac events are significantly different according to QASE grading in patients age <50 (B) and 50 years (D) and are similar irrespective of age with QASE-severe AR (p = 0.84). Abbreviations as in Figure 1.