Acute Heart Failure in Patients With Severe Aortic Stenosis - Insights From the CURRENT AS Registry.
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Nagao Kazuya, Taniguchi Tomohiko, Morimoto Takeshi, Shiomi Hiroki, Ando Kenji, Kanamori Norio, Murata Koichiro, Kitai Takeshi, Kawase Yuichi, Izumi Chisato, Miyake Makoto, Mitsuoka Hirokazu, Kato Masashi, Hirano Yutaka, Matsuda Shintaro, Inada Tsukasa, Murakami Tomoyuki, Takeuchi Yasuyo, Yamane Keiichiro, Toyofuku Mamoru, Ishii Mitsuru, Minamino-Muta Eri, Kato Takao, Inoko Moriaki, Ikeda Tomoyuki, Komasa Akihiro, Ishii Katsuhisa, Hotta Kozo, Higashitani Nobuya, Kato Yoshihiro, Inuzuka Yasutaka, Maeda Chiyo, Jinnai Toshikazu, Morikami Yuko, Saito Naritatsu, Minatoya Kenji, Kimura Takeshi, CURRENT AS Registry Investigators
Аннотация
METHODS AND RESULTS: From a Japanese multicenter registry enrolling consecutive patients with severe AS, 3,813 patients were categorized into the 3 groups according to the symptom of heart failure (HF); No HF (n=2,210), chronic HF (CHF) (n=813) and AHF defined as hospitalized HF at enrolment (n=790). Median follow-up was 1,123 days with 93% follow-up rate at 2 years. Risk factors for developing AHF included age, female sex, lower body mass index, untreated coronary artery stenosis, anemia, history of HF, left ventricular ejection fraction <50%, presence of any combined valvular disease, peak aortic jet velocity ≥5 m/s and tricuspid regurgitation pressure gradient ≥40 mmHg, and negative risk factors included dyslipidemia, history of percutaneous coronary intervention and hemodialysis. Respective cumulative 5-year incidences of all-cause death and HF hospitalization in No HF, CHF and AHF groups were 37.1%, 41.8% and 61.8% (P<0.001) and 20.7%, 33.8% and 52.3% (P<0.001). Even in the initial aortic valve replacement (AVR) stratum, AHF was associated with excess 5-year mortality risk relative to No HF and CHF (adjusted hazard ratio [HR] 1.64; 95% confidence interval [CI]: 1.14-2.36, P=0.008; adjusted HR 1.47; 95% CI: 1.03-2.11, P=0.03, respectively).
CONCLUSIONS: AHF complicating severe AS was associated with an extremely dismal prognosis, which could not be fully resolved by AVR. Careful management to avoid the development of AHF is crucial.