TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis

Abstract

BACKGROUND Frequency of heart failure (HF) and moderate aortic stenosis (AS) increases with age and often coincides. Afterload reduction is the mainstay of HF treatment. Aortic valve replacement (AVR) is only formally indicated for symptomatic severe AS. We aimed to evaluate the event rate in patients with depressed LV function and proven moderate AS. METHODS We created a multi-center retrospective database including all patients with depressed LV function (ejection fraction < 50%) and moderate AS (AVA 1.0 - 1.5 cm2) between 2010 and 2015. Endpoints were all-cause mortality, progression to severe AS requiring AVR and need for hospitalization for decompensated HF. RESULTS The study enrolled 310 patients with a mean age of 73 years and 75% were male. The majority was symptomatic (NYHA II: 41%; NYHA III: 29%; NYHA IV: 4%). Ischemic cardiomyopathy was present in 48% of patients and 12% had cardiac resynchronization therapy. Overall 72% of patients received beta-blocking agents, 48% ACE-inhibitors, 28% angiotensin receptor antagonists and 21% mineralocorticoid receptor antagonists. Half of the patients (44%) received oral anticoagulants. Median follow-up time was 688 days [IQR 304-1171]. All-cause mortality at 1 and 2 years were 10% and 20%, respectively. Hospitalizations for HF at 1 and 2 years occurred in 16% and 23%, respectively, with multiple admissions in one third. AVR was performed in 14% at 1 year and in 19% at 2 years, in two thirds surgical (SAVR) and in one third transcatheter (TAVR). CONCLUSION Patients with both HF and moderate AS are at high risk for mortality, hospitalization for decompensated HF and/or progression to severe aortic stenosis. Early valve replacement in these vulnerable patients may provide additional afterload reduction and impact clinical outcome. This hypothesis will be studied in the randomized Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial.