Prognostic impact of heart failure as an indication for intervention in severe aortic stenosis

Abstract Introduction Patients with severe aortic stenosis (SAS) and concomitant heart failure who do not undergo intervention have a poor prognosis. However, it remains unclear whether the adverse impact on prognosis persists following valve replacement. We hypothesize that the presence of heart failure prior to intervention identifies a subgroup of patients with severe aortic stenosis who exhibit worse clinical outcomes after undergoing surgical or transcatheter valve replacement. Methods We analyzed a retrospective registry of 451 patients with a median follow-up of 56 months (interquartile range: 40–73 months), who met the following criteria: 1) diagnosis of SAS with echocardiography; 2) symptoms with indication for valve replacement; 3) absence of other significant valve disease; 4) absence of coronary artery disease; 5) intervention with surgery (n=261) or TAVI (n=190); 6) survival beyond 30 days post-intervention. Results Patients with heart failure were older and exhibited higher rates of atrial fibrillation, reduced ejection fraction, lower tricuspid annular plane systolic excursion (TAPSE), increased pulmonary pressure, lower hemoglobin levels, and higher creatinine levels. Among the 133 patients with heart failure, 62 (47%) died during follow-up, compared to 67 of 318 patients without heart failure (21%, p0.001). The figure presents survival curves comparing patients with and without heart failure. Heart failure was identified as an independent predictor of persistent symptoms during follow-up (HR 1.67 1.05–2.67, p=0.03), cardiovascular mortality (HR 12.75 1.46–5.18, p=0.002), and overall mortality (HR 1.81 1.27–2.58, p=0.002). Within the cohort of 133 patients with heart failure, only advanced age (HR 1.05 1.01–1.09, p=0.007) and atrial fibrillation (HR 2.03 1.21–3.41, p=0.007) were independently associated with mortality (Table). Conclusions Valve intervention does not reduce the adverse prognostic impact of heart failure in severe aortic stenosis. These patients experience increased mortality during follow-up. These findings suggest the need for earlier therapeutic interventions in patients with severe aortic stenosis.Figure Table