{
  "abstract": "There has been a paradigm shift in our understanding of the natural history of chronic aortic regurgitation (AR) over the past few years. Previously considered a more benign valvular lesion, our long-held concepts in evaluating patients with AR and timing their surgery have evolved recently, to recognise that AR is not so benign in all patients. Chronic AR leads to combined pressure and volume overload on the left ventricle (LV), which has been long recognised.1 As a result, LV dilatation and hypertrophy ensue, initially considered adaptive, and the cardiac output is preserved. Many patients will spend years in this phase of progressive dilatation, and aortic valve replacement or repair (AVR) leads to reverse remodelling, rapid in most, even in those with quite large ventricles.2 3 However, the cohorts that informed our understanding of these concepts differ from more contemporary AR populations.4–6 In addition, the development of low LV ejection fraction or advanced symptoms associates with suboptimal outcomes after AVR,7 prompting the consideration of early intervention in asymptomatic patients with the goal of restoring the patient’s health trajectory to normal. Despite the focus on asymptomatic patients, many patients with AR are unfortunately undergoing AVR at class III and IV symptoms, suggesting much work needs to be done on early detection of significant AR and appropriate follow-up.",
  "authors": [
    {
      "affiliations": [
        "Houston Methodist Hospital, Houston, Texas, USA"
      ],
      "name": "Maan Malahfji"
    }
  ],
  "title": "Natural history of aortic regurgitation in the contemporary era: not so benign",
  "uid": "65dac7e1-54ee-5188-8342-ba2246046ff1"
}