Non‐severe aortic regurgitation increases short‐term mortality in acute heart failure with preserved ejection fraction

Abstract

Aims Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short-term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short-term mortality in AHF patients with reduced EF (AHFrEF), mid-range EF (AHFmrEF), or preserved EF (AHFpEF). Methods and results This mono-centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all-cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1-2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age-adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1-4.2]; P = 0.002). The age-adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9-57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5-1.8]; P = 0.875). Conclusions Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.

Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode

“…The present cohort is noteworthy for its overall old age (median age of 83 years). This old age is compatible with AHF registries recruiting within in the second decade of this millennium (77-82 years) [12][13][14] while patients were younger (70-80 years) in respective registries recruiting in the first decade. 15 Older age of heart failure patients has been related to longer survival with modern heart failure treatment as well as higher life expectancy.…”

“…Mean length of stay was 13 days [9][10][11][12][13][14][15][16][17][18][19] and not different between LVEF groups (pLVEF vs. mrLVEF vs. rLVEF: 13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs. 13 [9][10][11][12][13][14][15][16][17][18][19][20] vs. 13 [8][9][10][11][12][13][14][15][16] days, P = 0.68). Body weight decreased overall by À1.8 [À5.0 to 0] kg (Table 4, P = 0.0001), and this decrease was not significantly different between groups (Supporting Information, Table S3, P = 0.97).…”

Cardiac Surgery in Advanced Heart Failure

“…Furthermore, modern HF treatment attenuates progression of HF disease and prolongs survival with heart failure, and this beneficial effect will add further to the burden of advanced HF in the upcoming years [4]. Together, this concomitance explains why patients with worsening HF but also patients with de novo HF are older [5][6][7], which mandates the development of an algorithm taking care of the old patient with advanced HF.…”

“…The prognosis of advanced-stage HF remains poor with a 1-year mortality ranging from 25% to 75% [5][6][7]. Often, short-term therapy with inotropes remains the mainstay to improve the clinical condition and to reverse worsening end-organ function despite the fact that this treatment does not improve cardiovascular outcomes and even may worsen the prognosis [8].…”

Impact of concomitant mitral valve surgery on the clinical outcomes of patients with moderate functional mitral regurgitation and HFpEF undergoing aortic valve replacement: a cohort study

“…Being one of the major etiologies, aortic valve disease is not uncommon in heart failure patients [ 12 ]. Studies report that aortic valve disease can be seen in a substantial proportion of HFpEF patients [ 13 ], and even low-grade aortic valve disease in these patients can increase the risk of mortality [ 14 , 15 ]. Since it can have negative impact on the patient prognosis, the treatment of HFpEF, especially the etiological treatment, is critical.…”