Aortic regurgitation—most often associated with a bicuspid aortic valve—was identified as a previously underrecognized cause of sudden cardiac death linked to left ventricular remodeling and fibrosis, according to a recent study.
Aortic regurgitation occurs when the aortic valve does not close completely during diastole, allowing blood to flow back into the left ventricle. This reverse flow increases ventricular volume, leading to hypertrophy and dilation over time. Although aortic regurgitation (AR) is recognized as a cause of heart failure, its role in sudden cardiac death (SCD) has been less clearly defined. In a study published in Cardiovascular Pathology, the researchers examined AR as a cause of SCD and described associated aortic and ventricular remodeling, with particular attention to the presence of bicuspid aortic valve.
From a database of 8,551 SCD cases between 2014 and 2023, the researchers identified ten cases in which AR was the primary cause of death. Each underwent a complete autopsy and toxicology screen. The AR group included seven males and three females, with a mean age of 43 years. Compared with age- and sex-matched controls, the AR group had significantly higher heart weights (642±200 g vs 370±75 g, p<0.001), larger aortic annulus circumferences (73±14 mm vs 54±7 mm, p<0.001), and wider ascending aortic circumferences (85±27 mm vs 56±7 mm, p<0.001). The left ventricular cavity diameter was also greater in those with AR (52±15 mm vs 30±8 mm, p<0.001). No significant difference was observed in left ventricular wall thickness between the groups. Microscopic examination showed myocardial fibrosis in seven AR cases (70 percent).
A bicuspid aortic valve was identified in seven of the ten AR cases (70 percent). Two cases were associated with rheumatic disease, and one case involved a dilated tricuspid aortic valve. All AR hearts demonstrated regurgitant ridges and thickening along the free margins of the valve cusps, consistent with chronic regurgitation.
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