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The article discusses the relationship between aortic valve disease and heart failure with mildly reduced ejection fraction (HFmrEF). It highlights the importance of left ventricular ejection fraction (LVEF) as a prognostic factor and driver for intervention in valvular disease. The article also emphasizes the role of multimodality imaging in understanding LV remodeling and identifying other causes of LV dysfunction. The study by Schupp et al. provides insights into the risk stratification of HFmrEF patients with aortic valve disease, particularly aortic stenosis (AS). It suggests the need for improved knowledge of the interactions between valvular disease and LV function to optimize patient management. The article cautions against overinterpretation of the association between mild AS and poor outcomes, and highlights the underuse of interventions on the aortic valve in patients with severe AS and HFmrEF. It concludes by calling for further research to elucidate the underlying mechanisms of the association between valvular disease and impaired outcomes in HFmrEF patients. [Extracted from the article]

Aims: Tricuspid regurgitation (TR) is commonly observed in patients with severe left‐sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population. Methods and results: Among 6883 patients with severe native left‐sided VHD or previous left‐sided valvular intervention enrolled in the EURObservational Research Programme prospective VHD II survey, moderate or severe TR was very frequent in patients with severe mitral VHD (30% when mitral stenosis, 36% when mitral regurgitation [MR]), especially in patients with secondary MR (46%), and rare in patients with severe aortic VHD (4% when aortic stenosis, 3% when aortic regurgitation). An increase in TR grade was associated with a more severe clinical presentation and a poorer 6‐month survival (p < 0.0001). Rates of concomitant tricuspid valve (TV) intervention at the time of left‐sided heart valve surgery were high at the time of mitral valve surgery (50% when mitral stenosis, 41% when MR). Concordance between class I indications (patients with severe TR) for concomitant TV surgery at the time of left‐sided valvular heart surgery according to guidelines and real‐practice decision‐making was very good (88% overall, 95% in patients operated on for MR). Conclusion: In this large international prospective survey among patients with severe left‐sided VHD, moderate/severe TR was frequent in patients with mitral valve disease and was associated with a poorer outcome as TR grade increased. In patients with severe TR, compliance to guidelines for class I indications for concomitant TV surgery at the time of left‐sided heart valve surgery was very good. [ABSTRACT FROM AUTHOR]