Aortic stenosis leads to increased afterload, which may be detrimental in a failing left ventricle and has been associated with increased risk of heart failure hospitalizations and mortality in chronic heart failure. The prevalence and impact of aortic stenosis in acute heart failure is less well described. This post hoc analysis aimed to evaluate the prevalence and prognostic impact of aortic stenosis in a large cohort of patients hospitalized with acute heart failure. All patients from the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial with data available on aortic stenosis severity were included in the present analysis (n = 6241). Patients with severe aortic stenosis were ineligible for RELAX-AHF-2. Baseline characteristics, in-hospital outcomes, and 180-day clinical outcomes were compared between patients with and without aortic stenosis. Mild or moderate aortic stenosis was present in 454 (7.3%) patients. Patients with aortic stenosis were older, more often female, had more comorbidities and a higher left ventricular ejection fraction compared to patients without aortic stenosis. Mild or moderate aortic stenosis was associated with a higher risk of cardiovascular mortality or readmission for heart or renal failure (unadjusted Hazard Ratio (HR) 1.32, 95% CI 1.11 - 1.57). This association was maintained when adjusting for age and sex, but not after comprehensive multivariable adjustment (adjusted HR 1.04, 95% CI 0.82 - 1.32). The presence of mild or moderate aortic stenosis reflects an increased risk profile in patients with acute heart failure, but is not an independent predictor of poor clinical outcomes.
Venema et al. (Mon,) studied this question.