Predictors and Prognosis of Progression of Aortic Valve Stenosis in Patients Hospitalized with Heart Failure with Mildly Reduced Ejection Fraction

N. Abel (Mannheim)¹, M. Behnes (Mannheim)¹, A. Schmitt (Mannheim)¹, M. Reinhardt (Mannheim)¹, F. Lau (Mannheim)¹, K. J. Weidner (Mannheim)¹, M. Ayoub (Bad Oeynhausen)², K. A. Mashayekhi (Lahr/Schwarzwald)³, T. Bertsch (Nürnberg)⁴, I. Akin (Mannheim)¹, T. Schupp (Mannheim)^1
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; ²Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ³MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland; ⁴Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland

Background: Although aortic valve stenosis (AS) is a recognized predictor of heart failure (HF) outcome, limited data is available concerning predictors for and the prognostic value of progressive AS in patients with HF with mildly reduced ejection fraction (HFmrEF).

Methods: From 2016 to 2022, consecutive patients hospitalized with HFmrEF at one institution were retrospectively included. Predictors of AS progression were investigated using logistic regression analyses. Thereafter, the prognosis of patients with AS progression was compared to patients without regarding the primary endpoint long-term all-cause mortality (median follow-up at 30 months) using Kaplan-Meier and Cox regression analyses. The key secondary endpoint was rehospitalization for worsening HF.

Results: From a total of 603 patients hospitalized with HFmrEF, progressive AS was observed in 55 patients. Independent predictors of AS progression were older age at baseline (HR = 1.033; 95% CI 1.001 – 1.065; p = 0.042; per year increase), diabetes mellitus (HR = 1.851; 95% CI 1.019 – 3.363; p = 0.043) and baseline AS severity (mild AS: HR = 3.923; 95% CI = 1.605 – 9.588; p = 0.003, moderate AS: HR = 6.122; 95% CI 2.587 – 14.488; p = 0.001). AS progression was associated with an increased risk of long-term all-cause mortality (HR = 1.697; 95% CI 1.094 – 2.633; p = 0.018), but not with HF-related rehospitalization (p = 0.585). The association with long-term all-cause mortality was still evident after multivariable adjustment (p = 0.044).

Conclusion: AS progression in HFmrEF patients is independently associated with impaired long-term survival.