Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation
Background Aortic stenosis can lead to cardiac adaptations and symptoms similar to heart failure with preserved ejection fraction. We hypothesized that a heart failure with preserved ejection fraction phenotype in aortic stenosis is associated with earlier onset of symptoms and reduced symptomatic r...
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2025-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038786 |
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| author | Constantijn S. Venema Kees H. van Bergeijk Jan A. Krikken Hindrik W. van der Werf Ad F. M. van den Heuvel Yvonne L. Douglas Ify R. Mordi Nicolas Girerd Chim C. Lang Carolyn S. P. Lam Martin B. Leon Erik Lipsic Michiel Rienstra Adriaan A. Voors Joanna J. Wykrzykowska |
| author_facet | Constantijn S. Venema Kees H. van Bergeijk Jan A. Krikken Hindrik W. van der Werf Ad F. M. van den Heuvel Yvonne L. Douglas Ify R. Mordi Nicolas Girerd Chim C. Lang Carolyn S. P. Lam Martin B. Leon Erik Lipsic Michiel Rienstra Adriaan A. Voors Joanna J. Wykrzykowska |
| author_sort | Constantijn S. Venema |
| collection | DOAJ |
| description | Background Aortic stenosis can lead to cardiac adaptations and symptoms similar to heart failure with preserved ejection fraction. We hypothesized that a heart failure with preserved ejection fraction phenotype in aortic stenosis is associated with earlier onset of symptoms and reduced symptomatic response after transcatheter aortic valve implantation (TAVI). Methods and Results This retrospective cohort study included 469 patients with moderate aortic stenosis. We determined heavy, hypertension, atrial fibrillation, pulmonary, elder, filling pressure (H2FPEF) score at diagnosis and compared aortic peak jet velocity at onset of dyspnea in patients with low (<6) and high (≥6) H2FPEF score. In a separate cohort of 601 patients undergoing TAVI, we compared New York Heart Association class, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and cardiovascular mortality post‐TAVI between patients with low and high H2FPEF scores. In patients with aortic stenosis and a high H2FPEF score (n=43, 9.2%), the median peak jet velocity at onset of dyspnea was 4.2 versus 4.4 m/s in patients with a low H2FPEF score (P<0.001). After TAVI, a high H2FPEF score (n=123, 20%) was associated with a lower proportion of New York Heart Association class I at 30 days (49% versus 61%; P=0.04), persistently elevated NT‐proBNP, and higher 5‐year rate of cardiovascular mortality (36% versus 30%; P=0.012), compared with a low H2FPEF score. Conclusions Patients with aortic stenosis with a heart failure with preserved ejection fraction phenotype are more likely to develop symptoms at lower gradients and have worse outcomes post‐TAVI. Randomized trials are warranted to investigate whether medical therapy targeted at heart failure with preserved ejection fraction delays onset of symptoms and improves symptomatic response after TAVI. |
| format | Article |
| id | doaj-art-c7dbc4d0d7104107b9f8c2ba110dcd5e |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-c7dbc4d0d7104107b9f8c2ba110dcd5e2025-08-20T03:07:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-0114910.1161/JAHA.124.038786Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve ImplantationConstantijn S. Venema0Kees H. van Bergeijk1Jan A. Krikken2Hindrik W. van der Werf3Ad F. M. van den Heuvel4Yvonne L. Douglas5Ify R. Mordi6Nicolas Girerd7Chim C. Lang8Carolyn S. P. Lam9Martin B. Leon10Erik Lipsic11Michiel Rienstra12Adriaan A. Voors13Joanna J. Wykrzykowska14Department of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDivision of Molecular and Clinical Medicine, School of Medicine University of Dundee Dundee United KingdomCentre d’Investigation Clinique Pierre Drouin–INSERM–Unité Mixte de Recherche U1116 DCAC—CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu Nancy FranceDivision of Molecular and Clinical Medicine, School of Medicine University of Dundee Dundee United KingdomNational Heart Centre Singapore and Duke‐National University of Singapore SingaporeClinical Trials Center, Cardiovascular Research Foundation NY New York USADepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology and Cardiothoracic Surgery, Heart Center University of Groningen, University Medical Center Groningen Groningen The NetherlandsBackground Aortic stenosis can lead to cardiac adaptations and symptoms similar to heart failure with preserved ejection fraction. We hypothesized that a heart failure with preserved ejection fraction phenotype in aortic stenosis is associated with earlier onset of symptoms and reduced symptomatic response after transcatheter aortic valve implantation (TAVI). Methods and Results This retrospective cohort study included 469 patients with moderate aortic stenosis. We determined heavy, hypertension, atrial fibrillation, pulmonary, elder, filling pressure (H2FPEF) score at diagnosis and compared aortic peak jet velocity at onset of dyspnea in patients with low (<6) and high (≥6) H2FPEF score. In a separate cohort of 601 patients undergoing TAVI, we compared New York Heart Association class, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and cardiovascular mortality post‐TAVI between patients with low and high H2FPEF scores. In patients with aortic stenosis and a high H2FPEF score (n=43, 9.2%), the median peak jet velocity at onset of dyspnea was 4.2 versus 4.4 m/s in patients with a low H2FPEF score (P<0.001). After TAVI, a high H2FPEF score (n=123, 20%) was associated with a lower proportion of New York Heart Association class I at 30 days (49% versus 61%; P=0.04), persistently elevated NT‐proBNP, and higher 5‐year rate of cardiovascular mortality (36% versus 30%; P=0.012), compared with a low H2FPEF score. Conclusions Patients with aortic stenosis with a heart failure with preserved ejection fraction phenotype are more likely to develop symptoms at lower gradients and have worse outcomes post‐TAVI. Randomized trials are warranted to investigate whether medical therapy targeted at heart failure with preserved ejection fraction delays onset of symptoms and improves symptomatic response after TAVI.https://www.ahajournals.org/doi/10.1161/JAHA.124.038786aortic stenosisaortic valve interventionH2FPEF scoreheart failurestructural heart disease |
| spellingShingle | Constantijn S. Venema Kees H. van Bergeijk Jan A. Krikken Hindrik W. van der Werf Ad F. M. van den Heuvel Yvonne L. Douglas Ify R. Mordi Nicolas Girerd Chim C. Lang Carolyn S. P. Lam Martin B. Leon Erik Lipsic Michiel Rienstra Adriaan A. Voors Joanna J. Wykrzykowska Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis aortic valve intervention H2FPEF score heart failure structural heart disease |
| title | Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation |
| title_full | Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation |
| title_fullStr | Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation |
| title_full_unstemmed | Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation |
| title_short | Heart Failure With Preserved Ejection Fraction Phenotype Is Associated With Early Symptom Onset in Aortic Stenosis and Residual Symptoms After Transcatheter Aortic Valve Implantation |
| title_sort | heart failure with preserved ejection fraction phenotype is associated with early symptom onset in aortic stenosis and residual symptoms after transcatheter aortic valve implantation |
| topic | aortic stenosis aortic valve intervention H2FPEF score heart failure structural heart disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038786 |
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