{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T18:10:09Z","timestamp":1769883009693,"version":"3.49.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The optimal surgical timing for asymptomatic or equivocally symptomatic chronic severe aortic regurgitation with preserved left ventricular ejection fraction remains controversial.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Two hundred ten consecutive patients (median age 65\u2009years) with asymptomatic or equivocally symptomatic chronic severe aortic regurgitation and left ventricular ejection fraction \u226550% were registered. First, the treatment plans (aortic valve replacement or watchful waiting) after initial diagnosis were investigated. Then, 2 studies were set: Study A (n=144) investigated the prognosis of patients who were managed under the watchful waiting strategy after initial diagnosis; Study B (n=99) investigated the postoperative prognosis in patients who underwent aortic valve replacement at initial diagnosis or after watchful waiting. The primary outcomes were all\u2010cause death in Study A and postoperative cardiovascular events in Study B. In Study A, 3 died of noncardiovascular causes during a median follow\u2010up of 3.2\u2009years. In Kaplan\u2013Meier analysis, the survival curve was similar to that of an age\u2010sex\u2010matched general population in Japan. In Study B, 9 experienced the primary outcome during a median follow\u2010up of 5.0\u2009years. In Cox regression analysis, preoperative left ventricular end\u2010systolic diameter enlargement (hazard ratio, 1.11;\n              <jats:italic>P<\/jats:italic>\n              =0.048) and left ventricular end\u2010systolic diameter &gt;45\u2009mm (hazard ratio, 12.75;\n              <jats:italic>P<\/jats:italic>\n              =0.02) were significantly associated with poor postoperative prognosis. In Kaplan\u2013Meier analysis, left ventricular end\u2010systolic diameter &gt;45\u2009mm predicted a higher risk of the primary outcome (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Watchful waiting was achieved safely in asymptomatic or equivocally symptomatic chronic severe aortic regurgitation with preserved left ventricular ejection fraction. Preoperative left ventricular end\u2010systolic diameter &gt;45\u2009mm predicted a poor postoperative outcome and may be an optimal cut\u2010off value for surgical indication.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.036292","type":"journal-article","created":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T11:18:01Z","timestamp":1728645481000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of Watchful Waiting Strategy and Predictors of Postoperative Prognosis in Asymptomatic or Equivocally Symptomatic Chronic Severe Aortic Regurgitation With Preserved Left Ventricular Function"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9058-9258","authenticated-orcid":false,"given":"Sho","family":"Suzuki","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka 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