Anaemia in patients with aortic stenosis: influence on long‐term prognosis

Arnold C T Ng, William K F Kong, Vasileios Kamperidis, Matteo Bertini, M Louisa Antoni, Dominic Y Leung, Nina Ajmone Marsan, Victoria Delgado, Jeroen J Bax

The prognostic implications of anaemia in patients with aortic stenosis (AS) remain unclear. Accordingly, the present study aimed to evaluate the prognostic implications of anaemia in AS patients before and after aortic valve replacement (AVR). A total of 856 AS patients (age 71 ± 12 years, 60.2% male, 47.4% severe AS) were included. The mean haemoglobin (Hb) level was 13.2 ± 1.8 g/dL, and the prevalence of anaemia (Hb <13.0 g/dL for men, <12.0 g/dL for women) was 32.0%. The prevalence of anaemia rose with increasing severity of AS (28.9% and 35.6% in moderate and severe AS, respectively, P = 0.048) and was independently associated with increased all-cause mortality in severe AS patients whilst under medical therapy [hazard ratio (HR) 2.26, 95% confidence interval (CI) 1.29-3.97, P = 0.005). Similarly, each 1.0 g/dL decrease in Hb was independently associated with increased mortality risk at follow-up (HR 1.35, 95% CI 1.07-1.47, P = 0.006). However, after AVR surgery, severe AS patients who had anaemia had similar long-term survival as patients with normal Hb (log rank P = 0.19). When all AS patients were included and AVR surgery entered as a covariate, anaemia was still independently associated with increased all-cause mortality irrespective of the severity of AS. A high prevalence of anaemia in moderate and severe AS patients was observed, and its presence was independently associated with increased all-cause mortality. However, after AVR surgery, anaemic patients had similar survival rates as patients with normal Hb.