LAUSR

AIMS To investigate the epidemiological and prognostic relationship between heart failure and preserved ejection fraction (HFpEF) and left-sided valve surgery using all-cause mortality as a primary endpoint. METHODS AND RESULTS We studied a total of 973 patients, of whom 673 had undergone left-sided valve surgery (time from surgery to enrollment 50±30 months after valve surgery) and 300 patients with HFpEF without prior surgery served as control group. Among patients after surgery, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendation, 20.6% had no HF, and 12.0% had HF with mid-range or reduced ejection fraction (HFmrEF/HFrEF). During 83±39 months follow-up, a total of 335 (34.4%) patients died. Compared to surgical patients with no subsequent HF, patients with HFpEF and HFmrEF/HFrEF after surgery showed significantly higher all-cause mortality rates (HR 1.80 [95%CI: 1.25-2.57), p=0.001 and 1.86 [1.16-2.98], p=0.010' respectively). This increased mortality rate was similar to the control HFpEF group without surgery (HR 2.05 [1.38-3.02], p<0.001). Results remained consistent after adjustment for clinical and imaging risk factors and when using the established risk HFA-PEFF risk score for HFpEF diagnosis. Notably, only 12.5% of HFpEF patients after surgery were diagnosed with HF despite regular follow-up visits by board-certified cardiologists. In contrast, 92.1% of HFmrEF/HFrEF patients after surgery were diagnosed correctly. CONCLUSIONS HFpEF following left-sided valve surgery is highly prevalent, associated with unfavorable outcomes, but rarely recognized.