Changes in Aortic Valve Signal Heart Failure Progression

TOPLINE:

In patients with chronic heart failure (HF), the presence of aortic valve (AV) sclerosis appeared to reflect a more severe disease rather than serve as an independent prognostic factor for poor outcomes. This study suggested that its development should be viewed as a marker of disease progression.

METHODOLOGY:

• Researchers in Italy retrospectively analysed data of 1397 patients with chronic HF (mean age, 65.2 years; 83.4% men) enrolled between September 2006 and December 2019 to determine whether AV sclerosis can predict mortality and cardiovascular outcomes.
• The patients had a history of HF with reduced ejection fraction or left ventricular ejection fraction < 40%, had stable HF medications for at least 3 months, could perform a cardiopulmonary exercise test, and had no planned major interventions.
• The presence of AV sclerosis was identified using images from transthoracic echocardiography.
• The 5-year outcomes of interest were all-cause mortality and cardiovascular outcomes involving a composite of cardiovascular mortality, urgent heart transplant, or implantation of the left ventricular assist device.

TAKEAWAY:

• At baseline, 50.6% of patients had AV sclerosis; they were older and had a higher incidence of ischaemic HF and more severe HF, had worse renal function, and received more medical and device treatments than those without the condition.
• The presence of AV sclerosis at the time of HF diagnosis was linked to higher risks for all-cause mortality and cardiovascular outcomes; however, this association disappeared after adjusting for confounding factors.
• Among patients with follow-up echocardiograms, more than 40% developed AV sclerosis, particularly those older in age, with more severe HF, and with ischaemic cardiomyopathy and/or diabetes.
• Developing AV sclerosis during follow-up was associated with markedly higher risks for all-cause mortality (hazard ratio [HR], 3.7; P = .017) and cardiovascular outcomes (HR, 6.0; P = .020).

IN PRACTICE:

“Detecting the presence and new development of AV sclerosis could assist physicians in early identifying HF patients who may benefit most from closer clinical follow-up, more intensive therapy, and stricter risk factor control,” the authors wrote.

SOURCE:

This study was led by Veronika A. Myasoedova, MD, PhD, Centro Cardiologico Monzino, Milan, Italy. It was published online on June 06, 2025, in European Heart Journal Open.

LIMITATIONS:

This retrospective study included only patients who could undergo cardiopulmonary exercise testing, thus limiting the generalisability of the findings to those with more advanced HF. Follow-up echocardiography was available for only 55% of patients. AV sclerosis was expressed as either present or absent without any grading.

DISCLOSURES:

This study received support from the Italian Ministry of Health funds and Fondazione Gigi e Pupa Ferrari Onlus. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.