Background: Determining the value of new imaging markers to predict aortic valve (AV) surgery in asymptomatic patients with severe aortic regurgitation (AR) in a prospective, observational, multicenter study. Methods: Consecutive patients with chronic severe AR were enrolled between 2015-2018. Baseline examination included echocardiography (ECHO) with 2- and 3-dimensional (2D and 3D) vena contracta area (VCA), and magnetic resonance imaging (MRI) with regurgitant volume (RV) and fraction (RF) analyzed in CoreLab. Results: The mean follow-up was 587 days (interquartile range (IQR) 296-901) in a total of 104 patients. Twenty patients underwent AV surgery. Baseline clinical and laboratory data did not differ between surgically and medically treated patients. Surgically treated patients had larger left ventricular (LV) dimension, end-diastolic volume (all p < 0.05), and the LV ejection fraction was similar. The surgical group showed higher prevalence of severe AR (70% vs. 40%, p = 0.02). Out of all imaging markers 3D VCA, MRI-derived RV and RF were identified as the strongest independent predictors of AV surgery (all p < 0.001). Conclusions: Parameters related to LV morphology and function showed moderate accuracy to identify patients in need of early AV surgery at the early stage of the disease. 3D ECHO-derived VCA and MRI-derived RV and RF showed high accuracy and excellent sensitivity to identify patients in need of early surgery.

1st Faculty of Medicine Institute of Anatomy Charles University Prague Prague 12800 Czech Republic

Cardiovascular Center Aalst OLV Clinic 9300 Belgium

Department of Cardiology General University Hospital Prague 12808 Czech Republic

Department of Cardiology Institute for Clinical and Experimental Medicine Prague 14021 Czech Republic

Department of Cardiology Royal Vinohrady University Hospital Prague 10034 Czech Republic

Department of Cardiothoracic surgery Institute for Clinical and Experimental Medicine Prague 14021 Czech Republic

Faculty of Medicine in Hradec Králové Charles University Šimkova 870 Hradec Králové 500 03 Czech Republic

Institute for Clinical and Experimental Medicine Clinical and Transplant Pathology Centre Prague 14021 Czech Republic

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