Objective: This study aims to investigate the prevalence and prognostic value of aortic valve disease in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). 

Background: Limited data regarding the prognostic impact of aortic valve diseases in patients with HFmrEF is available. 

Methods: A large retrospective registry was used including all consecutive hospitalized patients with HFmrEF (i.e., left ventricular ejection fraction (LVEF) 41 – 49%) from 2016 to 2022 according to current European guidelines. The prognostic impact of moderate to severe aortic valve stenosis (AS) as well as regurgitation (AR) was compared to patients without (i.e., non-AS and non-RI, respectively). The primary endpoint was the first heart-failure related re-hospitalization at 3 years. Secondary endpoints comprised amongst others in-hospital mortality. Kaplan-Meier, uni- and multivariable Cox regression analyses were applied for statistics.

Results: 800 consecutive patients with HFmrEF were included. The prevalence of AS was 10% (moderate 6% and severe 4%) and AR 8% (moderate 7% and severe 1%). The risk of first heart-failure related hospitalization was not significantly affected by the presence of AS (14% vs. 8%; log rank p=0.092; HR= 1.727; 95% CI 0.908 - 3.284; p=0.096). However, HFmrEF patients with moderate to severe AI were associated with an increased risk of heart-failure related re-hospitalization compared to patients without (18% vs. 8%; log rank p=0.010; HR= 2.270; 95% CI 1.193 - 4.317; p=0.012). Even after multivariable adjustment, the risk of heart failure related re-hospitalization was still significantly higher in patients with moderate to severe AI (HR= 2.022; 95% CI 1.030 - 3.969; p=0.041). Finally, patients with moderate or severe AS and patients with moderate or severe AI revealed no significant difference of in-hospital mortality (4% vs. 3%; p=0.807 and 3% vs. 3%; p=0.946).

Conclusions: AR compared to AS reveals a negative impact on prognosis in HFmrEF patients.