Moderate aortic stenosis ups death risk in HFrEF patients

Moderate aortic stenosis (AS) has been linked to a significantly higher risk of mortality in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF; HFrEF), reveals a study. Aortic valve replacement (AVR), especially transcatheter AVR during follow-up, appears to improve survival in patients with HFrEF and moderate AS.

The authors analysed 262 patients with moderate AS (aortic valve area >1.0 and <1.5 cm²; and peak aortic jet velocity >2 and <4 m/s, at rest or after dobutamine stress echocardiography) and HFrEF (LVEF <50 percent). This cohort was matched 1:1 for age, sex, estimated glomerular filtration rate, New York Heart Association functional class III to IV, presence of diabetes, LVEF, and body mass index with those with HFrEF but no AS (ie, peak aortic jet velocity <2 m/s). Mean follow-up was 2.9±2.2 years.

Mean aortic valve area was 1.2±0.2 cm² and mean gradient was 14.5±4.7 mm Hg in the moderate AS group. Moderate AS correlated with a greater risk of mortality (hazard ratio [HR], 2.98, 95 percent confidence interval [CI], 2.08–4.31; p<0.0001) and of the composite of HF hospitalization and mortality (HR, 2.34, 95 percent CI, 1.72–3.21; p<0.0001).

In the moderate AS group, AVS performed in 44 patients at a median follow-up time of 10.9±16 months during the study resulted in improved survival (HR, 0.59, 95 percent CI, 0.35–0.98; p=0.04). Of note, surgical AVR did not significantly improve survival (p=0.92), but transcatheter AVR did (HR, 0.43, 95 percent CI, 0.18–1.00; p=0.05).

“These findings provide support to the realization of a randomized trial to assess the effect of early transcatheter AVR in patients with HFrEF and moderate AS,” the authors said.