{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:45:51Z","timestamp":1791254751255,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Ministry of Health and Welfare, Republic of Korea","award":["HI22C0154"],"award-info":[{"award-number":["HI22C0154"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Mixed aortic valve disease poses unique haemodynamic challenges. This study compared the clinical outcomes of concomitant moderate aortic stenosis (AS) and moderate aortic regurgitation to isolated AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed a multicentre cohort of valvular heart disease between 2008 and 2022 at three tertiary centres. The entire cohort was divided into three groups: moderate AS accompanied by moderate aortic regurgitation (moderate ASR), isolated severe AS, and isolated moderate AS. The primary outcome was a composite of cardiac death and hospitalization for heart failure. The final analysis included 4395 patients (median age: 76\u2005years, 50.8% male), comprising 224 patients with moderate ASR, 1996 with severe AS, and 2175 with moderate AS. Over a median follow-up of 3.4\u2005years, aortic valve replacement (AVR) rates were 11.1, 57.2, and 7.8 per 100 person-years in the moderate ASR, severe AS, and moderate AS groups, respectively (P &amp;lt; 0.001). Patients with moderate ASR had a significantly higher risk of the primary outcome compared with moderate AS [adjusted hazard ratio (aHR) 1.49; 95% confidence interval (CI) 1.15\u20131.92; P = 0.002] and a risk comparable to severe AS (aHR 1.28; 95% CI 1.00\u20131.64; P = 0.052). These results remained consistent even when AVR was included as a time-varying covariate. Older age, male sex, renal dysfunction, and lower left ventricular ejection fraction were independent predictors of the primary outcome in patients with moderate ASR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Moderate ASR should not be considered a benign condition, as it is associated with poor clinical outcomes comparable to those of severe AS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf252","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T11:52:42Z","timestamp":1757505162000},"page":"138-148","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic implications of moderate aortic stenosis with concomitant aortic regurgitation in degenerative aortic valve disease: insights from a multicentre cohort"],"prefix":"10.1093","volume":"27","author":[{"given":"Jihee","family":"Son","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Kyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-A","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Chol","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Woo","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , 81 Irwon-ro, Gangnam-gu, Seoul 06351 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9450-5653","authenticated-orcid":false,"given":"Jaehyun","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soongu","family":"Kwak","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4053-8713","authenticated-orcid":false,"given":"Jun-Bean","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5502-3977","authenticated-orcid":false,"given":"Seung-Pyo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-2131","authenticated-orcid":false,"given":"Hyung-Kwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine , Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iksung","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine , Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-3304","authenticated-orcid":false,"given":"Geu-Ru","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance 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