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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Pre-operative heart failure worsens outcome after aortic valve replacement irrespective of left ventricular ejection

Maria Thilén1, Stefan James1,2, Elisabeth Ståhle3

  • 1Department of Medical Sciences, Cardiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden.

European Heart Journal. Quality of Care & Clinical Outcomes
|February 5, 2021
PubMed

Insights

A history of heart failure or atrial fibrillation worsens outcomes after aortic valve replacement, regardless of left ventricular ejection fraction. These conditions may indicate underlying issues not captured by LVEF alone, suggesting a need for revised timing strategies for AVR.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Prognostics

Background:

  • Left ventricular ejection fraction (LVEF) is a key factor influencing outcomes after aortic valve replacement (AVR) for aortic stenosis (AS).
  • The prognostic value of co-existing cardiovascular diseases relative to pre-operative LVEF in AS patients undergoing AVR requires further investigation.

Purpose of the Study:

  • To assess the prognostic significance of pre-operative heart failure (HF) and atrial fibrillation (AF) in patients undergoing AVR for AS.
  • To determine if these conditions impact outcomes differently based on preserved or reduced LVEF.

Main Methods:

  • Analysis of a national heart disease register for adult patients undergoing AVR for AS between 2008-2014.
  • Utilized Cox regression to analyze all-cause mortality and heart failure hospitalization post-AVR, stratified by LVEF (preserved vs. reduced ≤50%).

Main Results:

  • 10,406 patients were included (median age 73 years, follow-up 35 months); 72.2% had preserved LVEF.
  • Pre-operative HF increased mortality risk irrespective of LVEF (HR 1.64 and 1.58).
  • Prior AF increased mortality risk with preserved LVEF (HR 1.62) but not reduced LVEF (HR 1.05). Both HF and AF increased post-operative HF hospitalization risk.

Conclusions:

  • Pre-operative HF and AF negatively impact post-operative prognosis in AVR patients, irrespective of LVEF.
  • HF and AF may serve as indicators of myocardial fibrosis not detected by LVEF, suggesting LVEF alone is suboptimal for timing AVR.
  • These findings highlight the importance of considering comorbidities beyond LVEF for optimizing AVR timing and patient management.
Abstract

Keywords:
Aortic stenosisDiastolic heart failureHFpEFHeart failureTAVI

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