Impact and prognostic implications of aortic stenosis across the heart failure spectrum

Abstract Background Aortic valve stenosis (AS) is associated with higher mortality and increased clinical event rates, particularly with impaired left ventricular function. Purpose The aim was to investigate the prevalence and impact of AS in heart failure (HF) patients. Methods This observational study analyzed 22,906 HF patients over a 10-year period form a tertiary care center. HF was diagnosed in accordance with current guidelines and AS was graded as mild, moderate, low-gradient (LG) and severe. Data on aortic valve replacement (AVR) was collected form each patient’s billing codes. The primary endpoint was all-cause mortality. Results Severe AS was present in 1504 patients (6.5%), moderate in 1260 patients (5.5%), and LG AS in 579 (2.5 %). HF with preserved ejection fraction was most common (70%, n = 15,941), but also HF with mildly-reduced and reduced ejection fraction was prevalent in more than moderate AS. Severe AS had the worst event-free survival with a 1-year event rate of 64%, followed by LG AS at 45% and moderate AS (24%) with long-term outcomes reflecting these results (Figure 1). The adverse short- and long-term impact of moderate or greater AS remained after adjustment for clinical confounders and was evident in all HF subtypes (Figure 2). Conclusion Patients with moderate or greater untreated AS have significantly higher mortality risk and dismal long-term survival outcomes in HF. These results remain significant after adjustment for clinical confounders and irrespective of HF subtype.Figure 1 Figure 2