Prognostic value of Heart-failure FAN score in patients with severe aortic stenosis undergoing valve replacement surgery

Background: The left ventricle ejection fraction (LVEF) may be preserved or decreased in aortic stenosis (AS). Aortic stenosis may result in left ventricular diastolic dysfunction and heart failure even without a decrease in the LVEF. The heart and liver are two organs that are closely related. The FAN score which is a liver function marker that comprises the fibrosis-4 index, albumin-bilirubin score (ALBI) and neutrophil-to-lymphocyte ratio (NLR) has recently been demonstrated to have a prognostic impact in heart failure. Objectives: This study investigated prognostic impact of the FAN score in patients undergoing surgery for aortic stenosis with preserved ejection fraction. Methods: After receiving approval from the Institutional Ethics Committee for this single-center, retrospective study, patients were screened to identify those who had undergone an isolated heart valve surgery for severe aortic stenosis with preserved LVEF between December 2015 and December 2024. Baseline demographics, echocardiographic, laboratory and surgical and performance status data were collected. The FAN scores and HF-FAN scores were calculated preoperatively. Results: A total of 86 patients were included in the study. Study patients were divided into survivor and deceased groups based on the survival status. The survivor group included 54 (the mean age 68.8 ± 12.0 years with %51.4 males) patients and deceased group included 32 patients (the mean age 74.3 ± 12.04 years, with %53.4 males). No significant differences were found between the study groups in gender distribution, whereas patients in the deceased group were statistically significantly older. Age, uric acid, ProBNP, NLR, CRP, the FIB-4 index, ALBI score, FAN score and HF-FAN score were identified as independent risk factors for mortality in the univariate and multivariate regression analyses. Furthermore, the ROC analysis revealed that the HF-FAN score was a better prognostic indicator than the FAN score, ALBI score, FIB-4 index and NLR. Conclusion: This study demonstrates that the FAN score is a simple and practical risk assessment tool for postoperative mortality in aortic stenosis with preserved ejection fraction . Moreover, this study revealed the superiority of the HF-FAN score over the original FAN core, in terms of sensitivity and specificity.