Impact of Moderate Aortic Stenosis in Patients With Heart Failure With Reduced Ejection Fraction

J Am Coll Cardiol. 2023 Apr 4;81(13):1235-1244. doi: 10.1016/j.jacc.2023.01.032.


Background: Afterload from moderate aortic stenosis (AS) may contribute to adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF).

Objectives: The authors evaluated clinical outcomes in patients with HFrEF and moderate AS relative to those without AS and with severe AS.

Methods: Patients with HFrEF, defined by left ventricular ejection fraction (LVEF) <50% and no, moderate, or severe AS were retrospectively identified. The primary endpoint, defined as a composite of all-cause mortality and heart failure (HF) hospitalization, was compared across groups and within a propensity score-matched cohort.

Results: We included 9,133 patients with HFrEF, of whom 374 and 362 had moderate and severe AS, respectively. Over a median follow-up time of 3.1 years, the primary outcome occurred in 62.7% of patients with moderate AS vs 45.9% with no AS (P < 0.0001); rates were similar with severe and moderate AS (62.0% vs 62.7%; P = 0.68). Patients with severe AS had a lower incidence of HF hospitalization (36.2% vs 43.6%; P < 0.05) and were more likely to undergo AVR within the follow-up period. Within a propensity score-matched cohort, moderate AS was associated with an increased risk of HF hospitalization and mortality (HR: 1.24; 95% CI: 1.04-1.49; P = 0.01) and fewer days alive outside of the hospital (P < 0.0001). Aortic valve replacement (AVR) was associated with improved survival (HR: 0.60; CI: 0.36-0.99; P < 0.05).

Conclusions: In patients with HFrEF, moderate AS is associated with increased rates of HF hospitalization and mortality. Further investigation is warranted to determine whether AVR in this population improves clinical outcomes.

Keywords: aortic stenosis; days alive out of hospital; heart failure hospitalization; heart failure with reduced ejection fraction; mortality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aortic Valve Stenosis* / complications
  • Aortic Valve Stenosis* / surgery
  • Heart Failure* / complications
  • Heart Failure* / epidemiology
  • Humans
  • Retrospective Studies
  • Stroke Volume
  • Ventricular Dysfunction, Left*
  • Ventricular Function, Left