Background

Valvular heart diseases (VHD), including single valve and multiple valve involvement, are highly prevalent clinical conditions. Previous studies mostly focused on the impact of single VHD on clinical outcome. The aim of the study was to evaluate the long-term all-cause mortality and cardiovascular (CV) mortality of heart failure (HF) patients with or without single-valve and multiple-valve VHD.

Methods

This is a retrospective cohort study with propensity score matching.  Patients were screened from our all-come HF cohort. Of the 4245 HF patients who referred to the cardiology department for diagnosis, treatment, and monitoring of VHD between 2004 and 2018, 1417 patients had no VHD and 2828 patients had at least one valve disease, including moderate to severe aortic stenosis (AS) or aortic regurgitation (AR), moderate to severe mitral stenosis (MS) or mitral regurgitation (MR), and moderate to severe tricuspid regurgitation (TR). Propensity score for each patient was calculated using logistic regression models, and 1016 patients without VHD and 1016 patients with VHD matched for age, sex, and NYHA class by propensity score matching were finally included in the final analysis. Primary endpoint was defined as mortality due to CV causes. The secondary endpoint was all-cause mortality.

Results

Mean age of included patients was 68±12 years, 77.4% were male. During median follow up of 30 (17-47) months, all-cause mortality and CV mortality was 24.1% and 10.2%, respectively. CV mortality was significantly higher in the VHD group than that in the no-VHD group (13.2% vs. 7.2%, P<0.001). All-cause mortality was similar between groups (25.8% vs. 22.4%, P=0.078). Compared to the no-VHD group, proportions of hyperlipidaemia, atrial fibrillation, hyperuricemia, and chronic kidney disease were significantly higher, while proportions of obesity, coronary artery disease, and diabetes were significantly lower in the VHD group. LV wall thickness and left ventricular ejection fraction (LVEF, 46.8±15.8% vs. 38.5±9.4%, P<0.001) were significantly higher in the VHD group than those in the no-VHD group (all P<0.001). All-cause mortality and CV mortality were significantly higher in patients with multiple VHD than those with single VHD (0- vs. 1- vs. 2- vs. 3-valve disease: all-cause mortality 22.4% vs. 21.5% vs. 32.1% vs. 43.3%, P<0.001; CV mortality 7.2% vs. 10.6% vs. 17.3% vs. 22.4%, P<0.001). Of 1016 patients with VHD, 462 (45.5%) patients did not underwent valve replacement or repair and 554 (54.5%) patients underwent at least one valve replacement or repair. All-cause mortality (18.6% vs. 34.4%, P<0.001) and CV mortality (10.6% vs. 16.2%, P=0.026) were significantly lower in patients with valve replacement or repair compared with those without surgery. Valve replacement or repair surgery significantly improved CV-death free survival (HR 0.631, 95% CI 0.441-0.903, P=0.012) after adjusted for age, sex, other clinical risk factors, and LVEF.

Conclusions

Compared with age, sex, and NYHA class matched chronic heart failure patients without VHD, concomitant VHD is associated with worse all-cause and CV mortality in proportion to the number of valves involved in patients with chronic heart failure. Valve replacement or repair can significantly reduce all-cause and CV mortality in this patient cohort.