ImportanceHeart failure (HF) and aortic stenosis (AS) frequently coexist, presenting a complex clinical challenge due to their intertwined pathophysiology and associated high morbidity and mortality. Despite numerous advancements in transcatheter and surgical aortic valve replacement (AVR), HF decompensation remains the leading cause of cardiac rehospitalization and a major predictor of mortality in patients with AS, before or after AVR. This review aims to provide a comprehensive analysis of the interplay between AS and HF, delving into myocardial changes caused by stenotic insult, the impact of AVR on these changes, and the prevalence and contributing elements of HF before and after AVR.ObservationsThe prevalence of HF remains high before and after AVR, particularly among patients with left ventricular dysfunction. Increased afterload from AS causes cardiac remodeling, which is initially benign but over time these changes become maladaptive, contributing to HF and increased mortality. The progression of HF is influenced by the degree of reverse cardiac remodeling, which can be affected by comorbid conditions, the hemodynamic performance of the valve prosthesis, and vascular stiffness. Several blood and imaging biomarkers offer insights into underlying AS pathophysiology, serving as mortality predictors and predicting HF in this patient population.Conclusions and RelevanceHF development in AS is multifactorial and its link to left ventricular dysfunction is a complex process. Delineating the determinants of HF admissions in AS is crucial for identifying individuals at high risk. Identifying the early signs of left ventricular decompensation by using surrogate markers may be the key, even before left ventricular function becomes impaired. Translating multimodality imaging techniques and biomarkers into routine clinical practice for evaluating cardiac damage and integrating these markers with patient and procedural factors that affect HF before and after AVR can facilitate timely intervention, minimizing the likelihood of HF progression and influencing future guidelines.

中文翻译：

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主动脉瓣狭窄、心力衰竭和主动脉瓣置换术


重要性心力衰竭 （HF） 和主动脉瓣狭窄 （AS） 经常共存，由于它们的病理生理学和相关的高发病率和死亡率交织在一起，带来了复杂的临床挑战。尽管经导管和外科主动脉瓣置换术 （AVR） 取得了许多进展，但 HF 失代偿仍然是心脏再住院的主要原因，也是 AS 患者在 AVR 之前或之后死亡的主要预测因素。本综述旨在全面分析 AS 和 HF 之间的相互作用，深入研究狭窄损伤引起的心肌变化、AVR 对这些变化的影响以及 AVR 前后 HF 的患病率和影响因素。观察结果 AVR 前后 HF 的患病率仍然很高，尤其是在左心室功能不全患者中。AS 后负荷增加会导致心脏重塑，最初是良性的，但随着时间的推移，这些变化变得适应不良，导致 HF 和死亡率增加。HF 的进展受反向心脏重塑程度的影响，反向心脏重塑的程度可能受合并症、瓣膜假体的血流动力学性能和血管刚度的影响。几种血液和影像学生物标志物提供了对潜在 AS 病理生理学的见解，可作为死亡率预测因子并预测该患者群体的 HF。结论和相关性 AS 中的 HF 发展是多因素的，它与左心室功能障碍的联系是一个复杂的过程。描述 AS 中 HF 入院的决定因素对于识别高危个体至关重要。通过使用替代标志物识别左心室失代偿的早期体征可能是关键，甚至在左心室功能受损之前。 将多模态成像技术和生物标志物转化为评估心脏损伤的常规临床实践，并将这些标志物与 AVR 前后影响 HF 的患者和程序因素相结合，可以促进及时干预，最大限度地减少 HF 进展的可能性并影响未来的指南。