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Moderate Aortic Stenosis in Patients With Heart Failure and Reduced Ejection Fraction

Guillaume Jean1, Nicolas M Van Mieghem2, Tea Gegenava3

  • 1Institut universitaire de cardiologie et de pneumologie, Université Laval, Québec, Québec, Canada.

Journal of the American College of Cardiology
|June 4, 2021
PubMed

Insights

Moderate aortic stenosis (AS) significantly increases mortality risk in heart failure with reduced ejection fraction (HFrEF) patients. Aortic valve replacement, particularly transcatheter AVR, improves survival in this population.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Moderate aortic stenosis (AS) is linked to poor prognosis in heart failure with reduced left ventricular ejection fraction (HFrEF).
  • The independent impact of moderate AS versus HFrEF on patient outcomes remains unclear.

Purpose of the Study:

  • To investigate the effect of moderate AS on mortality and heart failure hospitalization in patients with HFrEF.
  • To assess the impact of aortic valve replacement (AVR) on survival in this patient cohort.

Main Methods:

  • Matched cohort study comparing 262 patients with HFrEF and moderate AS to 262 patients with HFrEF and no AS.
  • Patients were matched for key clinical characteristics including LVEF, NYHA class, and comorbidities.
  • Primary endpoints included all-cause mortality and a composite of death and HF hospitalization.

Main Results:

  • Moderate AS was associated with a nearly threefold increased risk of mortality (HR: 2.98) and a 2.3-fold increased risk for the composite endpoint.
  • Aortic valve replacement (AVR) during follow-up was linked to improved survival (HR: 0.59).
  • Transcatheter AVR showed a significant survival benefit (HR: 0.43), while surgical AVR did not reach statistical significance.

Conclusions:

  • Moderate AS significantly elevates mortality risk in patients with HFrEF.
  • Aortic valve replacement, especially transcatheter AVR, improves survival in HFrEF patients with moderate AS.
  • Findings support a randomized trial for early transcatheter AVR in this population.
Abstract

Keywords:
aortic stenosisheart failure with reduced ejection fractionhospitalizationsurvival

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