Background Left ventricular ejection fraction (LVEF) affects outcome of valve replacement (AVR) in aortic stenosis (AS). The study aim was to investigate the prognostic importance of concomitant cardiovascular disease in relation to preoperative LVEF. Methods and results All adult patients undergoing AVR due to AS 2008-2014 in a national register for heart diseases were included. All-cause mortality and hospitalization for heart failure during follow-up after AVR, stratified by preserved or reduced LVEF (=50%), was derived from national patient registers and analyzed by Cox regression. During the study period 10,406 patients, median age 73 years, a median follow-up of 35 months were identified. Preserved LVEF was present in 7,512 (72.2%). Among them 647 (8.6%) had a history of heart failure (HF) and 1,099 (14.6%) atrial fibrillation (AF) before intervention. Preoperative HF was associated with higher mortality irrespective of preserved or reduced LVEF: Hazard Ratio (HR) 1.64 (95% C.I. 1.35 -1.99) and 1.58 (95% C.I. 1.30 -1.92). Prior AF was associated with a higher risk of mortality in patients with preserved but not in those with reduced LVEF: HR 1.62 (95% C.I. 1.36 -1.92) and 1.05 (95% C.I. 0.86 -1.28). Irrespective of LVEF preoperative HF and AF were associated with an increased risk of postoperative heart failure hospitalization. Conclusion In patients planned for AVR, a history of HF or AF, irrespective of LVEF, worsens the postoperative prognosis. HF and AF can be seen as markers of myocardial fibrosis not necessarily discovered by LVEF and the merely use of it, besides symptoms, for timing of AVR seems suboptimal.
Background In Aortic stenosis (AS) cardiovascular comorbidities as well as left ventricular ejection fraction (LVEF) have an impact on postoperative outcome among patients undergoing aortic valve replacement (AVR). The prevalence of heart failure (HF) based on LVEF in patients with severe AS varies. Lately HF with preserved LVEF has gained more attention. The aim is to describe the prevalence and prognostic impact of cardiovascular comorbidities, including HF, in relation to LVEF before AVR in a national cohort of patients with AS. Methods Patients >18 years, undergoing AVR due to AS 2008–2014 were identified in the national register for heart diseases, SWEDEHEART. Preoperative LVEF and comorbidities were collected from the register and enriched with data from national patient registries. The outcome events were all cause mortality and hospitalization for HF as the main diagnosis. The cohort was separated by preoperative LVEF status; preserved (>50%) or reduced (≤50%). Outcome events were analysed by Cox regression. Results 10406 patients, median age 73 (18–96) years whereof 3817 (36.7%) women, were included with a median follow-up of 35 months. In the cohort 15.9%, 73.9% and 10.2% received a mechanical, surgical biological and trans-catheter biological valve prosthesis, respectively. Preserved LVEF was present in 7512 (72.2%). Comorbidities were more frequent in the group with reduced LVEF (p<0.001). Irrespective of LVEF HF influenced outcome negatively (see table). Conclusion In patients planned for AVR a history of HF irrespective of LVEF worsen postoperative prognosis and a history of HF seems at least as important as LVEF when predicting long-term outcome. When stratifying patients for AVR with preserved LVEF, comorbidities such as HF and atrial fibrillation should be highlighted, and further research to identify risk factors for a negative postoperative outcome in this group seems important in optimizing the follow-up after AVR. Funding Acknowledgement Type of funding source: None
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