Valvular Heart Disease and Its Association With Death in Advanced Heart Failure

Area of Science:

• Cardiology
• Valvular Heart Disease
• Heart Failure Research

Background:

• Valvular heart disease is a known contributor to symptomatic heart failure.
• The prevalence and prognostic impact of valvular pathologies in advanced heart failure remain incompletely understood.

Purpose of the Study:

• To investigate the prevalence of specific valvular abnormalities in patients with advanced heart failure.
• To determine the independent association of key valvular pathologies (aortic stenosis, mitral regurgitation, tricuspid regurgitation) with cardiovascular and all-cause mortality in this population.

Main Methods:

• Retrospective population-based cohort study of advanced heart failure patients in Olmsted County, Minnesota (2007-2018).
• Echocardiographic assessment classified patients based on aortic, mitral, tricuspid, and pulmonic valve regurgitation and stenosis.
• Cox proportional hazards models were used to analyze the association of valvular disease with mortality through 2023.

Main Results:

• Among 936 patients, moderate or greater mitral regurgitation (26%), tricuspid regurgitation (42%), and aortic stenosis (9.7%) were prevalent.
• Clinically significant tricuspid or pulmonic stenosis was absent.
• After multivariable adjustment, moderate and severe aortic stenosis were independently associated with increased cardiovascular death (HR 1.42 and 1.55, respectively).

Conclusions:

• Tricuspid regurgitation, mitral regurgitation, and aortic stenosis were the most frequent moderate-to-severe valvular pathologies in advanced heart failure.
• Only moderate or greater aortic stenosis demonstrated an independent association with cardiovascular death in this patient group.