Prevalence, characteristics and prognostic impact of aortic valve disease in patients with heart failure and reduced, mildly reduced, and preserved ejection fraction: An analysis of the ESC Heart Failure Long‐Term Registry

Abstract

AimsTo assess the prevalence, clinical characteristics, and outcomes of patients with heart failure (HF) with or without moderate to severe aortic valve disease (AVD) (aortic stenosis [AS], aortic regurgitation [AR], mixed AVD [MAVD]).Methods and resultsData from the prospective ESC HFA EORP HF Long‐Term Registry including both chronic and acute HF were analysed. Of 15 216 patients with HF (62.5% with reduced ejection fraction, HFrEF; 14.0% with mildly reduced ejection fraction, HFmrEF; 23.5% with preserved ejection fraction, HFpEF), 706 patients (4.6%) had AR, 648 (4.3%) AS and 234 (1.5%) MAVD. The prevalence of AS, AR and MAVD was 6%, 8%, and 3% in HFpEF, 6%, 3%, and 2% in HFmrEF and 4%, 3%, and 1% in HFrEF. The strongest associations were observed for age and HFpEF with AS, and for left ventricular end‐diastolic diameter with AR. AS (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.23–1.67), and MAVD (adjusted HR 1.37, 95% CI 1.07–1.74) but not AR (adjusted HR 1.13, 95% CI 0.96–1.33) were independently associated with the 12‐month composite outcome of cardiovascular death and HF hospitalization. The associations between AS and the composite outcome were observed regardless of ejection fraction category.ConclusionsIn the ESC HFA EORP HF Long‐Term Registry, one in 10 patients with HF had AVD, with AS and MAVD being especially common in HFpEF and AR being similarly distributed across all ejection fraction categories. AS and MAVD, but not AR, were independently associated with increased risk of in‐hospital mortality and 12‐month composite outcome, regardless of ejection fraction category.

July 2023 at a glance: heart failure with preserved ejection fraction and comorbidities

“…Among 15 216 patients with HF enrolled in the ESC‐HFA EORP HF Long‐Term Registry including both chronic and acute HF (62.5% with HFrEF; 14.0% with HFmrEF; 23.5% with HFpEF), 706 (4.6%), 648 (4.3%) and 234 (1.5%) had moderate to severe aortic regurgitation, aortic stenosis and mixed aortic valve disease, respectively. Aortic stenosis and mixed aortic valve disease were more common among patients with HFpEF and were independently associated with an increased risk of in‐hospital mortality and 12‐month CV death and HF hospitalization, regardless of ejection fraction categories 27 …”

“…Aortic stenosis and mixed aortic valve disease were more common among patients with HFpEF and were independently associated with an increased risk of in-hospital mortality and 12-month CV death and HF hospitalization, regardless of ejection fraction categories. 27 A further analysis from the same registry investigated prevalence, clinical characteristics, and outcomes of patients with or without isolated or combined mitral regurgitation (MR) and tricuspid regurgitation (TR). Among 11 298 outpatients enrolled, 7541 (67%) had no MR/TR, 1931 (17%) had isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR.…”

Aortic regurgitation for adverse cardiovascular events: Really harmless or just hidden? Letter regarding the article ‘Prevalence, characteristics and prognostic impact of aortic valve disease in patients with heart failure and reduced, mildly reduced, and preserved ejection fraction: An analysis of the ESC Heart Failure Long‐Term Registry’

“…Using data from the prospective ESC HF Long-Term Registry, this study demonstrated that aortic stenosis (AS) and mixed AVD, but not aortic regurgitation (AR), were independently associated with an increased risk of in-hospital mortality and the composite outcome consisting of cardiovascular mortality and HF hospitalization. 1 We appreciate the valuable findings of Shahim et al 1 The authors should be congratulated for providing conclusive evidence of the impact of AVD on the prognosis of patients with HF. Interestingly, AR was not associated with either the composite outcome or in-hospital mortality.…”

“…We read with great interest the article by Shahim et al 1 published in this Journal which assessed the prevalence, characteristics and prognostic effect of moderate to severe aortic valve disease (AVD) in patients with heart failure (HF) across all ejection fraction categories. Using data from the prospective ESC HF Long-Term Registry, this study demonstrated that aortic stenosis (AS) and mixed AVD, but not aortic regurgitation (AR), were independently associated with an increased risk of in-hospital mortality and the composite outcome consisting of cardiovascular mortality and HF hospitalization.…”

“…Previous studies have shown that these medications are associated with reduced all-cause mortality and cardiovascular events in patients with moderate to severe AR. 2 However, the use of these medications was not adjusted in the article by Shahim et al 1 Therefore, the disequilibrium in this baseline medication use might influence the association between AR and the outcomes, leading to the finding that AR was not significantly associated with the risk of the outcomes.…”