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

Aims: To assess the prevalence, clinical characteristics, and outcomes of patients with heart failure (HF) with or without moderate to severe aortic valve disease (AVD) (stenosis, AS; regurgitation, AR; mixed MAVD). Methods and results: Data from the prospective ESC HFA EORP HF Long-Term Registry including both chronic and acute HF were analyzed. Of 15 216 patients with HF (62.5% reduced EF, HFrEF; 14.0% mildly reduced, HFmrEF; 23.5% preserved, 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 (LVEDD) with AR. AS (adjusted HR 1.43, 95% CI 1.23-1.67), and MAVD (1.37, 95% CI 1.07-1.75) but not AR (1.13, 95% CI 0.96-1.33) were independently associated with the 12-month composite outcome of CV death and HF hospitalization. The associations between AS and the composite outcome were observed regardless of EF category. Conclusions: In the ESC HFA EORP HF Long-Term Registry, one in ten patients with HF had AVD, with AS and MAVD being especially common in HFpEF and AR being similarly distributed across all EF categories. AS and MAVD, but not AR, were independently associated with increased risk of in-hospital mortality and 12-month composite outcome, regardless of EF category. This article is protected by copyright. All rights reserved.