Published: 31-05-2023 12:51 | Updated: 18-09-2023 16:43

The sisters characterize valvular disease in heart failure

In the largest survey to date, researchers at Karolinska Institutet have studied how diseases of the aortic valve affect prognosis in patients with various types of heart failure. The study was published in the European Journal of Heart Failure. Shared first authors are sisters Angiza and Bahira Shahim, who also presented the results of the study at the Heart Failure International Conference in Prague.

Angiza shahim och Bahira Shahim.
Angiza Shahim och Bahira Shahim. Photo: Narwan Askaryar

Heart failure is one of the most common causes of death and hospitalizations globally. A common belief is that heart failure always means that the heart's pumping ability is reduced resulting in reduced ejection fraction, but in the last decade, large studies have shown that heart failure with preserved pumping ability is at least as common and dangerous. The latest international guidelines divide heart failure into three different types: heart failure with reduced, mildly reduced or preserved ejection fraction. Valvular diseases are greatly overrepresented in heart failure, but until now there has been a large gap in knowledge regarding how often they occur in the various types of heart failure, and how they affect the patients' prognosis.

- We used a large European registry with roughly 15,000 heart failure patients to map valvular diseases in the three different types of heart failure. One of our most important findings was that narrowing of the aortic valve (the valve between the heart's left chamber and the main artery) affects the prognosis very negatively regardless of the type of heart failure involved, while leakage across the valve (backflow) does not seem to play as important a role in the prognosis, says Angiza Shahim, PhD student at Karolinska Institutet, Department of Medicine, Solna and doctor at ME Thoracic surgery.

-These findings are fundamental because there is a  lack of reference material for how aortic valve diseases affect prognosis in different types of heart failure in the contemporary era and have important implications for future trials of valvular interventions, says Bahira Shahim, researcher at Karolinska Institutet, Department of Medicine, Solna and doctor at ME Cardiology.

And how well it works to collaborate with her sister in research, Bahira knows the answer to.

- We work very well together and complement each other. We don't always agree, but as an older sister you think you're always right, laughs Bahira.

Lars Lund
Lars Lund, professor at Karolinska Institutet. Photo: Martin Stenmark


Lars Lund is a professor at Karolinska Institutet, Department of Medicine Solna and senior author of the study.

- We are learning more and more about heart failure with reduced, mildly reduced or preserved ejection fraction and this work contributes important new knowledge about the occurrence and impact of valvular diseases in different heart failure populations, says Lars Lund.



Prevalence, Characteristics and Prognostic Impact of Aortic Valve Disease in Patients with Heart Failure and Reduced, Mildly Reduced, and Preserved Ejection Fraction: An Analysis of the ESC Heart Failure Long-Term Registry.
Shahim B, Shahim A, Adamo M, Chioncel O, Benson L, Shahim B, Crespo-Leiro MG, Anker SD, Coats AJS, Filippatos G, Lainscak M, McDonagh T, Mebazaa A, Piepoli MF, Rosano GMC, Ruschitzka F, Savarese G, Seferovic P, Volterrani M, Leiro MC, Cubero JS, Amir O, Palic B, Maggioni AP, Metra M, Lund LH
Eur J Heart Fail 2023 May;():