Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made.

Background: Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) still experience a high rate of in-hospital complications. Liver fibrosis (LF) is a risk factor for mortality in the general population. However its prognostic role in ACS patients has been poorly investigated. Purpose: We investigated whether the presence of LF detected by the validated fibrosis-4 (FIB-4) score may indicate ACS patients at higher risk of poor outcome. Methods: In the prospective ongoing REAl-world observationaL rEgistry of Acute Coronary Syndrome (REALE-ACS), LF was defined by a FIB-4 score >3.25. The primary endpoint was in-hospital adverse events (AEs) including a composite of in-hospital cardiogenic shock, PEA/asystole, acute pulmonary edema and death. Results: A total of 469 consecutive ACS consecutive patients were enrolled. Overall, 21.1% of patients had a FIB-4 score >3.25. Patients with LF were older, less frequently on P2Y12 inhibitors (p=0.021) and admitted with higher serum levels of white blood cells (p<0.001), neutrophils to lymphocytes ratio (p<0.001), C-reactive protein (p=0.013), high-sensitive troponin T (p<0.001), creatin-kinase MB (p<0.001), D-Dimer levels (p<0.001). STEMI presentation and higher Killip class/GRACE score were more common in the LF group (p3.25 (OR 3.1, 95% CI 1.4 to 6.9), admission left ventricular ejection fraction% below median (OR 9.2, 95% CI 3.9 to 21.7) and Killip class ≥II (OR 6.3, 95% CI 2.2 to 18.4) were the strongest independent predictors of in-hospital AEs. Conclusions: LF detected by FIB-4 score >3.25 was associated with more severe ACS presentation and worse in-hospital AEs irrespective of clinical and laboratory variables. Funding Acknowledgement: Type of funding sources: None.