Long-term prognostic value of Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score in patients undergoing isolated surgical aortic valve replacement for severe aortic stenosis.

Abstract

The Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score was proposed as a diagnostic tool for heart failure with preserved left ventricular ejection fraction. This study aimed to evaluate the prognostic value of the Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score in patients undergoing isolated surgical aortic valve replacement for severe aortic stenosis with preserved ventricular ejection fraction. A total of 193 patients who underwent isolated surgical aortic valve replacement for severe aortic stenosis with preserved ventricular ejection fraction (≥50%) between October 2012 and April 2017 were retrospectively analyzed. Patients with a Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score 5 points or more were categorized as having a "high score," 2 to 4 points as an "intermediate score," and 1 point or less as a "low score." The primary end point was a composite of cardiovascular mortality and adverse cardiac events. During a median follow-up of 5.9 years, cardiovascular death occurred in 13 patients (6.7%) and 22 patients (11.4%) were readmitted for heart failure or arrhythmia. Eighty-two patients (54.4%) exhibited a high score, which was associated with a higher risk of the primary end point, compared with those with an intermediate and a low score (log-rank, P = .0030). In multivariable analysis, the Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score was identified as an independent predictor of the primary end point (hazard ratio, 1.47; 95% CI, 1.07-2.10; P = .023). Among patients with a preoperative high score, 56% improved to an intermediate score at 6 months, with a significantly lower risk of the primary end point than those with a persistent high score; none improved to a low score. The Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score predicts the long-term cardiovascular mortality and adverse cardiac events in patients undergoing isolated surgical aortic valve replacement for severe aortic stenosis with persevered ventricular ejection fraction.