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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]

Aim: Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients with heart failure (HF). The aim of this study was to investigate prevalence, clinical characteristics and outcomes of patients with or without isolated or combined MR and TR across the entire HF spectrum. Methods and results: The ESC‐HFA EORP HF Long‐Term Registry is a prospective, multicentre, observational study including patients with HF and 1‐year follow‐up data. Outpatients without aortic valve disease were included and stratified according to isolated or combined moderate/severe MR and TR. Among 11 298 patients, 7541 (67%) had no MR/TR, 1931 (17%) isolated MR, 616 (5.5%) isolated TR and 1210 (11%) combined MR/TR. Baseline characteristics were differently distributed across MR/TR categories. Compared to HF with reduced ejection fraction, HF with mildly reduced ejection fraction was associated with a lower risk of isolated MR (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.60–0.80), and distinctly lower risk of combined MR/TR (OR 0.51; 95% CI 0.41–0.62). HF with preserved ejection fraction (HFpEF) was associated with a distinctly lower risk of isolated MR (OR 0.42; 95% CI 0.36–0.49), and combined MR/TR (OR 0.59; 95% 0.50–0.70), but a distinctly increased risk of isolated TR (OR 1.94; 95% CI 1.61–2.33). All‐cause death, cardiovascular death, HF hospitalization and combined outcomes occurred more frequently in combined MR/TR, isolated TR and isolated MR versus no MR/TR. The highest incident rates were observed in isolated TR and combined MR/TR. Conclusion: In a large cohort of outpatients with HF, prevalence of isolated and combined MR and TR was relatively high. Isolated TR was driven by HFpEF and was burdened by an unexpectedly poor outcome. [ABSTRACT FROM AUTHOR]