Response to discussion forum: Prognostic implications of moderate aortic stenosis with concomitant aortic regurgitation in degenerative aortic valve disease: insights from a multicentre cohort

We appreciate the insightful comments by Xing-yu Ji et al. regarding our study on the prognostic significance of moderate aortic stenosis (AS) with concomitant aortic regurgitation (AR).1 In their correspondence, Xing-yu Ji et al. raised two important points. We agree that an integrated echocardiographic assessment is essential in this population. Aortic stenosis concomitant aortic regurgitation (ASR) may increase transvalvular flow, influencing Doppler-derived gradients and potentially leading to overestimation of stenosis severity. There remains a need for refined diagnostic parameters tailored to mixed lesions. In our study, evaluation primarily relied on the aortic valve area by the continuity equation and the vena contracta width (VCW) for AR, as regurgitant fraction could not be measured due to the retrospective multicentre design. Despite these limitations, aortic valve area remains a reliable parameter for assessing mixed aortic valve disease.2 Moreover, the VCW of AR, which is less affected by loading conditions, provides strong correlation with quantitative indices such as effective regurgitant orifice area and regurgitant volume, supporting its diagnostic value in grading AR severity.3 Given the complex haemodynamics of mixed aortic valve disease, comprehensive evaluation using multiple echocardiographic parameters is required, and when findings are inconclusive, complementary multimodality imaging can be considered. Ultimately, there remains a need to establish more specific diagnostic criteria for mixed aortic valve disease.