Heart failure with preserved ejection fraction after left-sided valve surgery: prevalent and relevant

Andreas A Kammerlander, Christian Nitsche, Carolina Donà, Matthias Koschutnik, Varius Dannenberg, Katharina Mascherbauer, Robert Schönbauer, Amna Zafar, Max-Paul Winter, Philipp E Bartko, Georg Goliasch, Christian Hengstenberg, Julia Mascherbauer

Research output: Journal article (peer-reviewed)Journal article

5 Citations (Scopus)

Abstract

AIMS: To investigate the epidemiological and prognostic relationship between heart failure with preserved ejection fraction (HFpEF) and left-sided valve surgery using all-cause mortality as a primary endpoint.

METHODS AND RESULTS: We studied a total of 973 patients, of whom 673 had undergone left-sided valve surgery (time from surgery to enrolment 50 ± 30 months after valve surgery) and 300 patients with HFpEF without prior surgery served as control group. Among patients after surgery, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendations, 20.6% had no heart failure (HF), and 12.0% had HF with mid-range or reduced ejection fraction (HFmrEF/HFrEF). During 83 ± 39 months of follow-up, a total of 335 (34.4%) patients died. Compared to surgical patients with no subsequent HF, patients with HFpEF and HFmrEF/HFrEF after surgery showed significantly higher all-cause mortality rates [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.25-2.57, P = 0.001; and HR 1.86, 95% CI 1.16-2.98, P = 0.010, respectively]. This increased mortality rate was similar to the control HFpEF group without surgery (HR 2.05, 95% CI 1.38-3.02, P < 0.001). Results remained consistent after adjustment for clinical and imaging risk factors and when using the established HFA-PEFF risk score for HFpEF diagnosis. Notably, only 12.5% of HFpEF patients after surgery were diagnosed with HF despite regular follow-up visits by board-certified cardiologists. In contrast, 92.1% of HFmrEF/HFrEF patients after surgery were diagnosed correctly.

CONCLUSIONS: Heart failure with preserved ejection fraction following left-sided valve surgery is highly prevalent, associated with unfavourable outcomes, but rarely recognized.

Original languageEnglish
Pages (from-to)2008-2016
Number of pages9
JournalEuropean Journal of Heart Failure
Volume23
Issue number12
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Heart Failure/diagnosis
  • Humans
  • Prognosis
  • Stroke Volume
  • Ventricular Dysfunction, Left
  • Ventricular Function, Left

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