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Acute Heart Failure in Patients With Severe Aortic Stenosis　- Insights From the CURRENT AS Registry

Kazuya Nagao1, Tomohiko Taniguchi2, Takeshi Morimoto3

  • 1Department of Cardiovascular Center, Osaka Red Cross Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|October 31, 2017
PubMed

Insights

Acute heart failure in severe aortic stenosis patients indicates a poor prognosis, even after aortic valve replacement. Early intervention and careful management are crucial to prevent acute heart failure development.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Valvular Heart Disease

Background:

  • Clinical profiles of acute heart failure (AHF) in severe aortic stenosis (AS) patients are not well-defined.
  • Understanding AHF in AS is critical for improving patient outcomes.

Purpose of the Study:

  • To investigate the clinical characteristics and prognosis of patients with severe AS, stratified by heart failure (HF) status.
  • To identify risk factors for developing AHF in severe AS.

Main Methods:

  • A Japanese multicenter registry identified 3,813 severe AS patients, categorized into No HF, chronic HF (CHF), and AHF groups.
  • Median follow-up was 1,123 days, with 5-year incidences of all-cause death and HF hospitalization analyzed.
  • Risk factors for AHF and outcomes post-aortic valve replacement (AVR) were assessed.

Main Results:

  • AHF patients (n=790) had significantly higher 5-year mortality (61.8%) and HF hospitalization rates (52.3%) compared to No HF and CHF groups.
  • Risk factors for AHF included older age, female sex, lower BMI, untreated coronary stenosis, anemia, prior HF, reduced ejection fraction, combined valvular disease, and high-velocity AS.
  • Even after AVR, AHF remained associated with increased mortality risk (adjusted HR 1.64 for No HF, 1.47 for CHF).

Conclusions:

  • Acute heart failure in severe aortic stenosis carries an extremely poor prognosis.
  • Aortic valve replacement alone does not fully resolve the excess mortality risk associated with AHF.
  • Preventing the development of AHF in severe AS patients is essential for improving long-term outcomes.
Abstract

Keywords:
Acute heart failureAortic stenosisPrognosis

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