Abstract
Background: The study investigators previously reported that moderate aortic stenosis (AS) is associated with a poor prognosis in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF) (HFrEF). However, the respective contribution of moderate AS versus HFrEF to the outcomes of these patients is unknown. Objectives: This study sought to determine the impact of moderate AS on outcomes in patients with HFrEF. Methods: The study included 262 patients with moderate AS (aortic valve area >1.0 and <1.5 cm2; and peak aortic jet velocity >2 and <4 m/s, at rest or after dobutamine stress echocardiography) and HFrEF (LVEF <50%). These patients were matched 1:1 for sex, age, estimated glomerular filtration rate, New York Heart Association functional class III to IV, presence of diabetes, LVEF, and body mass index with patients with HFrEF but no AS (i.e., peak aortic jet velocity <2 m/s). The endpoints were all-cause mortality and the composite of death and HF hospitalization. Results: A total of 262 patients with HFrEF and moderate AS were matched with 262 patients with HFrEF and no AS. Mean follow-up was 2.9 ± 2.2 years. In the moderate AS group, mean aortic valve area was 1.2 ± 0.2 cm2, and mean gradient was 14.5 ± 4.7 mm Hg. Moderate AS was associated with an increased risk of mortality (hazard ratio [HR]: 2.98; 95% confidence interval [CI]: 2.08 to 4.31; p < 0.0001) and of the composite of HF hospitalization and mortality (HR: 2.34; 95% CI: 1. 72 to 3.21; p < 0.0001). In the moderate AS group, aortic valve replacement (AVR) performed in 44 patients at a median follow-up time of 10.9 ± 16 months during follow-up was associated with improved survival (HR: 0.59; 95% CI: 0.35 to 0.98; p = 0.04). Notably, surgical AVR was not significantly associated with improved survival (p = 0.92), whereas transcatheter AVR was (HR: 0.43; 95% CI: 0.18 to 1.00; p = 0.05). Conclusions: In this series of patients with HFrEF, moderate AS was associated with a marked incremental risk of mortality. AVR, and especially transcatheter AVR during follow-up, was associated with improved survival in patients with HFrEF and moderate AS. These findings provide support to the realization of a randomized trial to assess the effect of early transcatheter AVR in patients with HFrEF and moderate AS.
| Original language | English |
|---|---|
| Pages (from-to) | 2796-2803 |
| Number of pages | 8 |
| Journal | Journal of the American College of Cardiology |
| Volume | 77 |
| Issue number | 22 |
| DOIs | |
| Publication status | Published - 8 Jun 2021 |
Bibliographical note
Funding Information:The Department of Cardiology of the Erasmus Medical Center Rotterdam has received research grants from Claret Medical, Boston Scientific, Medtronic, and Edwards Lifesciences. The Department of Cardiology of the Leiden University Medical Center has received research grants from Medtronic, Biotronik, Edwards Lifesciences, and Boston Scientific. Dr. Delgado has received speaker fees from Abbott Vascular. Dr. Pibarot has received research grants from Edwards Lifesciences; and has echocardiography core laboratory research contracts with Edwards Lifesciences and Medtronic. Dr. Van Mieghem has received research grants from Claret Medical, Boston Scientific, Medtronic, and Edwards Lifesciences. Dr. Clavel has a computed tomography core laboratory research contract with Edwards Lifesciences; and has received a research grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
