Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Eur J Heart Fail. 2023 Jul;25(7):1049-1060. doi: 10.1002/ejhf.2908. Epub 2023 Jun 6.
To assess the prevalence, clinical characteristics, and outcomes of patients with heart failure (HF) with or without moderate to severe aortic valve disease (AVD) (aortic stenosis [AS], aortic regurgitation [AR], mixed AVD [MAVD]).
Data from the prospective ESC HFA EORP HF Long-Term Registry including both chronic and acute HF were analysed. Of 15 216 patients with HF (62.5% with reduced ejection fraction, HFrEF; 14.0% with mildly reduced ejection fraction, HFmrEF; 23.5% with preserved ejection fraction, HFpEF), 706 patients (4.6%) had AR, 648 (4.3%) AS and 234 (1.5%) MAVD. The prevalence of AS, AR and MAVD was 6%, 8%, and 3% in HFpEF, 6%, 3%, and 2% in HFmrEF and 4%, 3%, and 1% in HFrEF. The strongest associations were observed for age and HFpEF with AS, and for left ventricular end-diastolic diameter with AR. AS (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.23-1.67), and MAVD (adjusted HR 1.37, 95% CI 1.07-1.74) but not AR (adjusted HR 1.13, 95% CI 0.96-1.33) were independently associated with the 12-month composite outcome of cardiovascular death and HF hospitalization. The associations between AS and the composite outcome were observed regardless of ejection fraction category.
In the ESC HFA EORP HF Long-Term Registry, one in 10 patients with HF had AVD, with AS and MAVD being especially common in HFpEF and AR being similarly distributed across all ejection fraction categories. AS and MAVD, but not AR, were independently associated with increased risk of in-hospital mortality and 12-month composite outcome, regardless of ejection fraction category.
评估伴有或不伴有中重度主动脉瓣疾病（主动脉瓣狭窄[AS]、主动脉瓣反流[AR]、混合性主动脉瓣疾病[MAVD]）的心力衰竭（HF）患者的患病率、临床特征和结局。
对前瞻性 ESC HFA EORP HF 长期注册研究中的慢性和急性 HF 数据进行了分析。在 15216 例 HF 患者（62.5%射血分数降低，HFrEF；14.0%射血分数轻度降低，HFmrEF；23.5%射血分数保留，HFpEF）中，706 例（4.6%）有 AR，648 例（4.3%）有 AS，234 例（1.5%）有 MAVD。AS、AR 和 MAVD 在 HFpEF 中的患病率分别为 6%、8%和 3%，HFmrEF 中分别为 6%、3%和 2%，HFrEF 中分别为 4%、3%和 1%。年龄和 HFpEF 与 AS 的相关性最强，左心室舒张末期直径与 AR 的相关性最强。AS（调整后的危险比[HR]1.43，95%置信区间[CI]1.23-1.67）和 MAVD（调整后的 HR 1.37，95% CI 1.07-1.74）而不是 AR（调整后的 HR 1.13，95% CI 0.96-1.33）与 12 个月心血管死亡和 HF 住院的复合结局独立相关。AS 与复合结局之间的关联在射血分数类别中观察到。
在 ESC HFA EORP HF 长期注册研究中，每 10 例 HF 患者中就有 1 例患有 AVD，AS 和 MAVD 尤其常见于 HFpEF，而 AR 在所有射血分数类别中分布相似。AS 和 MAVD，而不是 AR，与住院死亡率和 12 个月复合结局的风险增加独立相关，无论射血分数类别如何。
