{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:36:34Z","timestamp":1789425394191,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Multivalvular heart disease (MVD), defined as coexisting lesions in two or more valves, poses significant diagnostic and prognostic challenges. While isolated valvular heart disease (VHD) is well characterized, the impact of moderate aortic regurgitation (AR) with another concomitant moderate VHD remains unclear. Current guidelines focus mainly on isolated severe lesions, potentially underestimating moderate MVD. This study assessed the prevalence and prognostic impact of concomitant moderate VHD in patients with moderate AR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively analyzed 794 patients with \u2265 moderate AR (2017\u20132023) from a dedicated echocardiographic database. Groups were: isolated moderate AR (n = 178), isolated significant AR (n = 214), and moderate AR plus \u2265 one concomitant moderate VHD (n = 402). Significant AR was defined by the presence of \u22651 echocardiographic severity criterion. Exclusion criteria included cardiomyopathy, prior cardiac surgery, LVEF &amp;lt;50%, or severe VHD other than AR. Follow-up was 24 months for a composite endpoint of all-cause mortality and heart failure hospitalization (HHF). VHD severity was graded per guidelines. Patients with moderate AR plus another VHD were older (79.9 vs. 66.4 years, P &amp;lt; 0.001), with more comorbidities and larger left atria. During follow-up, 151 patients (18.8%) met the composite endpoint (63 HHF, 108 deaths). Moderate AR with another VHD independently predicted higher risk [HR 2.83 (95% CI: 1.32\u20136.03; P = 0.007)], comparable to isolated significant AR [HR 2.65 (95% CI: 1.23\u20135.70; P = 0.013)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Moderate AR with another concomitant moderate VHD carries a prognosis similar to significant AR, indicating this combination is not benign and may be underestimated by current guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeag045","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:32:31Z","timestamp":1770726751000},"page":"1059-1067","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic significance of concomitant valvular disease in moderate aortic regurgitation"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2728-5023","authenticated-orcid":false,"given":"Giorgia","family":"Benzoni","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca , Piazza dell\u2019Ateneo Nuovo 1, 20126 Milan ,","place":["Italy"]},{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Doctoral School, Alcal\u00e1 University , Pl. San Diego s\/n, 28801, Alcal\u00e1 de Henares, Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Gonz\u00e1lez G\u00f3mez","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Salud Carlos III (ISCIII) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Monteagudo Ru\u00edz","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Salud Carlos III (ISCIII) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Ramos Cano","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Doctoral School, Alcal\u00e1 University , Pl. San Diego s\/n, 28801, Alcal\u00e1 de Henares, Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Hinojar","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Salud Carlos III (ISCIII) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Carri\u00f3n S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalila","family":"Nappa","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II , Naples 80131 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Mart\u00ednez Vives","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Garc\u00eda Martin","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Garc\u00eda Sebastian","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Zamorano","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Doctoral School, Alcal\u00e1 University , Pl. San Diego s\/n, 28801, Alcal\u00e1 de Henares, Madrid ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Salud Carlos III (ISCIII) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Covadonga","family":"Fern\u00e1ndez-Golf\u00edn","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Ram\u00f3n y Cajal , Carretera de Colmenar Km 9.100, Madrid 28034 ,","place":["Spain"]},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) , Madrid ,","place":["Spain"]},{"name":"CIBERCV, Instituto de Salud Carlos III (ISCIII) , Madrid 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