Importance Volumetric measurements by transthoracic echocardiogram may better reflect left ventricular (LV) remodeling than conventional linear LV dimensions. However, the association of LV volumes with mortality in patients with chronic hemodynamically significant aortic regurgitation (AR) is unknown.

Objective To assess whether LV volumes and volume-derived LV ejection fraction (Vol-LVEF) are determinants of mortality in AR.

Design, Setting, and Participants This cohort study included consecutive asymptomatic patients with chronic moderately severe to severe AR from a tertiary referral center (January 2004 through April 2019).

Exposures Clinical and echocardiographic data were analyzed retrospectively. Aortic regurgitation severity was graded by comprehensive integrated approach. De novo disk-summation method was used to derive LV volumes and Vol-LVEF.

Main Outcome and Measures Associations between all-cause mortality under medical surveillance and the following LV indexes: linear LV end-systolic dimension index (LVESDi), linear LVEF, LV end-systolic volume index (LVESVi), and Vol-LVEF.

Results Of 492 asymptomatic patients (mean [SD] age, 60 [17] years; 425 men [86%]), ischemic heart disease prevalence was low (41 [9%]), and 453 (92.1%) had preserved linear LVEF (≥50%) with mean (SD) LVESVi of 41 (15) mL/m². At a median (interquartile range) of 5.4 (2.5-10.1) years, 66 patients (13.4%) died under medical surveillance; overall survival was not different than the age- and sex-matched general population (P = .55). Separate multivariate models, adjusted for age, sex, Charlson Comorbidity Index, and AR severity, demonstrated that in addition to linear LVEF and LVESDi, LVESVi and Vol-LVEF were independently associated with mortality under surveillance (all P < .046) with similar C statistics (range, 0.83-0.84). Spline curves showed that continuous risks of death started to rise for both linear LVEF and Vol-LVEF less than 60%, LVESVi more than 40 to 45 mL/m², and LVESDi above 21 to 22 mm/m². As dichotomized variables, patients with LVESVi more than 45 mL/m² exhibited increased relative death risk (hazard ratio, 1.93; 95% CI, 1.10-3.38; P = .02) while LVESDi more than 20 mm/m² did not (P = .32). LVESVi more than 45 mL/m² showed a decreased survival trend compared with expected population survival.

Conclusions and Relevance In this large asymptomatic cohort of patients with hemodynamically significant AR, LVESVi and Vol-LVEF worked equally as well as LVESDi and linear LVEF in risk discriminating patients with excess mortality. A LVESVi threshold of 45 mL/m² or greater was significantly associated with an increased mortality risk.

重要性 经胸超声心动图的体积测量可能比传统的线性 LV 尺寸更好地反映左心室 (LV) 重塑。然而，慢性血流动力学显着主动脉瓣关闭不全 (AR) 患者的 LV 容积与死亡率之间的关系尚不清楚。

目的 评估 LV 容积和容积衍生的 LV 射血分数 (Vol-LVEF) 是否是 AR 死亡率的决定因素。

设计、设置和参与者 该队列研究包括来自三级转诊中心（2004 年 1 月至 2019 年 4 月）的连续无症状慢性中重度至重度 AR 患者。

暴露 临床和超声心动图数据进行了回顾性分析。主动脉瓣关闭不全严重程度采用综合综合方法分级。从头磁盘求和方法用于导出 LV 卷和 Vol-LVEF。

主要结果和措施 医学监测下全因死亡率与以下 LV 指数之间的关联：线性 LV 收缩末期尺寸指数 (LVESDi)、线性 LVEF、LV 收缩末期容积指数 (LVESVi) 和 Vol-LVEF。

结果 在 492 名无症状患者（平均 [SD] 年龄，60 [17] 岁；425 名男性 [86%]）中，缺血性心脏病患病率低（41 [9%]），453 名（92.1%）保持线性 LVEF (≥50%) 平均 (SD) LVESVi 为 41 (15) mL/m ²。在 5.4（2.5-10.1）年的中位数（四分位距）中，66 名患者（13.4%）在医学监测下死亡；总体生存率与年龄和性别匹配的一般人群没有差异（P  = .55）。单独的多变量模型，对年龄、性别、查尔森合并症指数和 AR 严重程度进行了调整，表明除了线性 LVEF 和 LVESDi 之外，LVESVi 和 Vol-LVEF 与监测中的死亡率独立相关（所有P < .046) 具有相似的 C 统计量（范围，0.83-0.84）。样条曲线显示，线性 LVEF 和 Vol-LVEF 均低于 60%、LVESVi 高于 40 至 45 mL/m ²和 LVESDi 高于 21 至 22 mm/m ²时，持续死亡风险开始上升。作为二分变量，LVESVi 大于 45 mL/m ²的患者表现出相对死亡风险增加（风险比，1.93；95% CI，1.10-3.38；P  = .02），而 LVESDi 大于 20 mm/m ²则没有（P  = .32)。与预期人群存活率相比， LVESVi 大于 45 mL/m ²显示出存活率下降的趋势。

结论和相关性 在这一血流动力学显着 AR 患者的大型无症状队列中，LVESVi 和 Vol-LVEF 与 LVESDi 和线性 LVEF 在高死亡率风险区分患者中的作用相同。^{45 mL/m 2}或更高的 LVESVi 阈值与死亡风险增加显着相关。