Myasoedova Veronika A, Salvioni Elisabetta, Bonomi Alice, Galotta Arianna, Mapelli Massimo, Mattavelli Irene, Rusconi Valentina, Bertolini Francesca, Campodonico Jeness, Contini Mauro C, Massaiu Ilaria, Valerio Vincenza, Poggio Paolo, Agostoni Piergiuseppe
Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan 20138, Italy.
Department of Clinical and Community Sciences, University of Milan, Via della Commenda 19, Milan 20122, Italy.
Eur Heart J Open. 2025 Jun 6;5(3):oeaf066. doi: 10.1093/ehjopen/oeaf066. eCollection 2025 May.
Heart failure (HF) continues to pose a major clinical challenge, making the identification of high-risk HF patients crucial for improving patient care, optimizing resource allocation, and streamlining healthcare processes. Among various risk models, the metabolic exercise test data combined with cardiac and kidney indexes score stands out as a strong predictor of HF prognosis. However, the relationship between aortic valve (AV) sclerosis, an emerging marker of cardiovascular disease, and HF prognosis are currently poorly studied.
We evaluated 1397 HF patients (2006-2019) and AV sclerosis was identified by transthoracic echocardiography. All-cause mortality and composite cardiovascular outcomes were assessed. Statistical analyses included Kaplan-Meier curves and Cox regression models. Time-dependent analyses were conducted to evaluate the role of AV sclerosis development in HF patients. At baseline, 707 patients presented AV sclerosis (50.6%). Patients with AV sclerosis were older and had more severe HF. After 5 years, AV sclerosis at baseline was linked to increased all-cause mortality (HR = 1.4, 95% CI: 1.1-1.8; = 0.005) and cardiovascular outcomes (HR = 1.4, 95% CI: 1.0-2.0; = 0.044) but, after adjustment for all variables different between the two groups, significance was lost. Further echocardiographic evaluation of patients without AV sclerosis at baseline reveals that AV sclerosis development, observed in >40% of cases, was strongly associated with all-cause mortality (HR = 3.4, 95% CI: 1.3-10.8; = 0.017) and cardiovascular outcomes (HR = 6.0, 95% CI: 1.3-26.9; = 0.02).
In HF, AV sclerosis is a marker of HF severity and its development should be considered a marker of disease progression rather than an independent prognostic factor for poor outcomes.
心力衰竭（HF）仍然是一项重大的临床挑战，因此识别高危HF患者对于改善患者护理、优化资源分配和简化医疗流程至关重要。在各种风险模型中，代谢运动测试数据与心脏和肾脏指标评分相结合，是HF预后的有力预测指标。然而，作为心血管疾病新兴标志物的主动脉瓣（AV）硬化与HF预后之间的关系目前研究较少。
我们评估了1397例HF患者（2006 - 2019年），并通过经胸超声心动图确定AV硬化情况。评估全因死亡率和复合心血管结局。统计分析包括Kaplan - Meier曲线和Cox回归模型。进行时间依赖性分析以评估AV硬化进展在HF患者中的作用。在基线时，707例患者存在AV硬化（50.6%）。有AV硬化的患者年龄更大，HF更严重。5年后，基线时的AV硬化与全因死亡率增加相关（HR = 1.4，95% CI：1.1 - 1.8；P = 0.005）和心血管结局相关（HR = 1.4，95% CI：1.0 - 2.0；P = 0.044），但在对两组之间所有不同变量进行调整后，相关性消失。对基线时无AV硬化的患者进行进一步超声心动图评估发现，超过40%的病例出现AV硬化进展，这与全因死亡率（HR = 3.4，95% CI：1.3 - 10.8；P = 0.017）和心血管结局（HR = 6.0，95% CI：1.3 - 26.9；P = 0.02）密切相关。
在HF中，AV硬化是HF严重程度的标志物，其进展应被视为疾病进展的标志物，而非不良结局的独立预后因素。
