Heart failure with preserved ejection fraction after surgical aortic valve replacement: prevalence, prognosis and predictors

Background Symptoms of heart failure (HF) often persist even after surgical aortic valve replacement (SAVR). However, the prevalence and prognostic significance of heart failure with preserved ejection fraction (HFpEF) after SAVR remain unclear. Objective This study aimed to assess the prevalence, long-term outcomes, and predictors of HFpEF after successful SAVR. Methods 320 patients were prospectively followed with a comprehensive clinical and echocardiographic evaluation before and after SAVR. Results One year after surgery 110 patients (34.4%) were not relieved of symptoms, presenting with NYHA class ≥ II (Figure 1). 63 patients (19.7%) met the diagnostic criteria for HFpEF, 36 patients (11.3%) had heart failure with reduced ejection fraction (HFrEF), and 221 patients (69.1%) were free from HF. Six year follow-up revealed that HFpEF was associated with an increased risk of major adverse cardiovascular events (unadj. HR 2.47, 95% CI 1.01–6.04; p = 0.048), primarily driven by HF-related hospitalizations (unadj. HR 4.49, 95% CI 1.21–16.74; p = 0.025). Independent predictors of HFpEF were age (aOR 1.04, 95% CI 1.01–1.07; p < 0.001), body mass index (aOR 1.07, 95% CI 1.01–1.13; p = 0.018), smoking (aOR 2.33, 95% CI 1.20–4.53; p = 0.013), and a preoperative HFA-PEFF score ≥ 5 (aOR 2.76, 95% CI 1.41–5.42; p = 0.003). Conclusion This cohort study observed 20% HFpEF prevalence after successful SAVR and HFpEF was associated with adverse long-term outcomes. Age, obesity, smoking, and HFA-PEFF scores were found to be independent predictors of postoperative HFpEF, which may guide perioperative risk stratification and early postoperative management.