Prognostic significance of early stage aortic valve disease development in heart failure: insights from the MECKI score cohort

Aims Heart failure (HF) continues to pose a major clinical challenge, making the identification of high-risk HF patients crucial for improving patient care, optimizing resource allocation, and streamlining healthcare processes. Among various risk models, the metabolic exercise test data combined with cardiac and kidney indexes score stands out as a strong predictor of HF prognosis. However, the relationship between aortic valve (AV) sclerosis, an emerging marker of cardiovascular disease, and HF prognosis are currently poorly studied. Methods and results We evaluated 1397 HF patients (2006-2019) and AV sclerosis was identified by transthoracic echocardiography. All-cause mortality and composite cardiovascular outcomes were assessed. Statistical analyses included Kaplan-Meier curves and Cox regression models. Time-dependent analyses were conducted to evaluate the role of AV sclerosis development in HF patients. At baseline, 707 patients presented AV sclerosis (50.6%). Patients with AV sclerosis were older and had more severe HF. After 5 years, AV sclerosis at baseline was linked to increased all-cause mortality (HR = 1.4, 95% CI: 1.1-1.8; P = 0.005) and cardiovascular outcomes (HR = 1.4, 95% CI: 1.0-2.0; P = 0.044) but, after adjustment for all variables different between the two groups, significance was lost. Further echocardiographic evaluation of patients without AV sclerosis at baseline reveals that AV sclerosis development, observed in >40% of cases, was strongly associated with all-cause mortality (HR = 3.4, 95% CI: 1.3-10.8; P = 0.017) and cardiovascular outcomes (HR = 6.0, 95% CI: 1.3-26.9; P = 0.02). Conclusion In HF, AV sclerosis is a marker of HF severity and its development should be considered a marker of disease progression rather than an independent prognostic factor for poor outcomes.