While heart failure with preserved ejection fraction (HFpEF) is associated with poor medical outcomes, its prognostic role in cardiothoracic surgery is still unclear. Conversely, EuroSCORE II is the most proven and used risk stratification score in such setting. This study aimed to assess HFpEF prognostic value after cardiothoracic surgery, taking into account EuroSCORE II.

In a prospective cohort, patients with LVEF≥50% undergoing cardiothoracic surgery were included. HFpEF patients were compared to control patients. HFpEF was defined as per 2016 ESC guidelines: LVEF≥50%, symptomatic HF with New York Heart Association (NYHA)≥2 and elevated BNP. Primary endpoint was time to intrahospital mortality; secondary endpoint was postoperative shock. Multivariate survival and logistic regression analyses were performed.

Among 1743 patients included. Four hundred and twenty-seven (24.5%) presented HFpEF. Mortality was higher among HFpEF patients as compared to control patients (7.0% vs 3.2%, P-value<0.001). HFpEF was independently associated with postoperative intrahospital mortality (adjusted hazard-ratio=1.6 [95 CI 1.0–2.6], P=0.049). HFpEF patients presented with more postoperative shock than control patients (17.8% vs. 6.7% P<0.001). HFpEF was independently associated with postoperative shock (adjusted odd-ratio=2.9 [95CI 1.5–3.0], P<0.001).

For a given EuroSCORE II, patients presenting with HFpEF had increased postoperative mortality as compared with control patients. HFpEF is an independent risk factor regarding postoperative cardiothoracic surgery.