Impact of Mild and Moderate Aortic Stenosis in Acute Heart Failure: Insights From RELAX-AHF-2.

Background: Aortic stenosis leads to increased afterload, which may be detrimental in a failing left ventricle and has been associated with an increased risk of hospitalizations due to heart failure and mortality in chronic heart failure. The prevalence and impact of aortic stenosis in acute heart failure are less well described. This post hoc analysis aimed to evaluate the prevalence and prognostic impact of aortic stenosis in a large cohort of patients hospitalized due to acute heart failure.

Methods and results: All patients from the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial with data available on aortic stenosis severity were included in the present analysis (n = 6241). Patients with severe aortic stenosis were ineligible for RELAX-AHF-2. Baseline characteristics, in-hospital outcomes and 180-day clinical outcomes were compared between patients with and without aortic stenosis. Mild or moderate aortic stenosis was present in 454 (7.3%) patients. Patients with aortic stenosis were older, more commonly female, had more comorbidities, and had higher left ventricular ejection fractions compared to patients without aortic stenosis. Mild or moderate aortic stenosis was associated with a higher risk of cardiovascular mortality or readmission for heart or renal failure (unadjusted hazard ratio (HR) 1.32, 95% CI 1.11-1.57). This association was maintained when adjusting for age and sex, but not after comprehensive multivariable adjustment (adjusted HR 1.04, 95% CI 0.82-1.32).

Conclusion: The presence of mild or moderate aortic stenosis reflects an increased risk profile in patients with acute heart failure, but it is not an independent predictor of poor clinical outcomes.