Management of Moderate Aortic Regurgitation

Surveillance and Monitoring

The European Society of Cardiology recommends echocardiographic surveillance every 1-2 years to detect progression to severe disease or development of left ventricular dysfunction 1, 2, 3
Clinical assessment should occur yearly to identify symptom development, with more frequent imaging (every 3-6 months) warranted if there are significant changes in LV ejection fraction or progressive LV dilatation 1, 2

The European Society of Cardiology recommends blood pressure control with antihypertensive treatment for patients with hypertension (systolic BP >140 mmHg) 1, 2
Vasodilators that do not slow heart rate, such as ACE inhibitors or dihydropyridine calcium channel blockers (e.g. nifedipine), should be used for blood pressure control 1, 2, 4, 5
Beta blockers should be avoided as they prolong diastole and increase regurgitant volume 4, 5

The European Society of Cardiology recommends that surgery is NOT indicated for moderate AR alone, but should be considered in specific circumstances, such as concurrent CABG, mitral valve surgery, or ascending aorta surgery (Class IIa recommendation) 1, 2, 3
The decision for concurrent valve surgery should account for the etiology of AR, patient age, disease progression trajectory, and possibility of valve repair 6

The European Society of Cardiology recommends monitoring for markers that indicate progression to severe AR, including vena contracta ≥0.6 cm, regurgitant volume ≥60 mL/beat, effective regurgitant orifice area (EROA) ≥0.3 cm², evidence of LV dilatation, holodiastolic flow reversal in the descending aorta, development of symptoms, and decline in LV ejection fraction below 50-55% 1, 2, 3

Amlodipine is an appropriate antihypertensive agent for patients with moderate aortic regurgitation who have hypertension, as dihydropyridine calcium channel blockers like amlodipine provide vasodilation without slowing heart rate, which is critical to avoid increasing regurgitant volume 7

The European Society of Cardiology explicitly endorses dihydropyridine calcium channel blockers such as amlodipine alongside ACE inhibitors as preferred vasodilators for blood pressure control in patients with moderate aortic regurgitation 8, 7
Vasodilators reduce left ventricular afterload and can decrease LV volume and mass while improving LV performance in aortic regurgitation 9
Maintaining or slightly increasing heart rate is beneficial in aortic regurgitation, as it shortens diastolic filling time and thereby reduces the regurgitant volume per cardiac cycle 8, 7

Consider ACE inhibitors or ARBs as equally appropriate alternatives to amlodipine for hypertension management in moderate aortic regurgitation 8, 7
RAS blockade may offer additional advantages through beneficial effects on LV fibrosis, though both drug classes are guideline-endorsed 9