Dataset Information

The impact of atrial fibrillation on prognosis in aortic stenosis.

ABSTRACT:

Background

Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor.

Objective

To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function.

Methods

Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality.

Results

In total, 2849 patients with significant AS (mean age 72 ± 12 years, 54.8% men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30-97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P < 0.001). On univariable (HR: 1.42; 95% CI: 1.25-1.62; P < 0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02-1.38; P = 0.026), AF was independently associated with mortality. However, when correcting for indexed left atrial volume, E/e' or both, AF was no longer independently associated with all-cause mortality.

Conclusion

Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.

SUBMITTER: Laenens D

PROVIDER: S-EPMC10745267 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

The impact of atrial fibrillation on prognosis in aortic stenosis.

Laenens Dorien D Stassen Jan J Galloo Xavier X Ewe See Hooi SH Singh Gurpreet K GK Ammanullah Mohammed R MR Hirasawa Kensuke K Sia Ching-Hui CH Butcher Steele C SC Chew Nicholas W S NWS Kong William K F WKF Poh Kian Keong KK Ding Zee P ZP Ajmone Marsan Nina N Bax Jeroen J JJ

European heart journal. Quality of care & clinical outcomes 20231201 8

<h4>Background</h4>Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor.<h4>Objective</h4>To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function.<h4>Methods</h4>Patients with first diagnosis of significant AS were selected and stratified accord ...[more]

PMID: 36669758

Similar Datasets

Project description:BackgroundAtrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS).ObjectivesThis study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice.MethodsWe identified 909 asymptomatic patients from 3,208 consecutive patients with aortic valve area ≤1.0 cm2 and left ventricular ejection fraction ≥50% at a tertiary academic center. Patients were grouped by rhythm at the time of transthoracic echocardiogram [SR: 820/909 (90%) and AF: 89/909 (10%)]. Propensity-matched analyses (2 SR:1 AF) matching 174 SR to 89 AF patients by age, sex, and clinical comorbidities were used to compare outcomes.ResultsIn the propensity-matched cohort, median age (82 ± 8 vs. 81 ± 9 years, p = 0.31), sex distribution (male 58% vs. 52%, p = 0.30), and Charlson comorbidity index (4.0 vs. 3.0, p = 0.26) were not different in AF vs. SR. Median follow-up duration was 2.6 (IQR: 1.0-4.4) years. The 1-year rate of aortic valve replacement (AVR) was not different (AF: 32% vs. SR: 37%, p = 0.31). All-cause mortality was higher in AF [hazard ratio (HR): 1.68 (1.13-2.50), p = 0.009]. Independent predictors of mortality were age [HR: 1.92 (1.40-2.62), p < 0.001], Charlson comorbidity index [1.09 (1.03-1.15), p = 0.002], aortic valve peak velocity [HR: 1.87 (1.20-2.94), p = 0.006], stroke volume index [HR: 0.75 (0.60-0.93), p = 0.01], moderate or more mitral regurgitation [HR: 2.97 (1.43-6.19), p = 0.004], right ventricular systolic dysfunction [HR: 2.39 (1.29-4.43), p = 0.006], and time-dependent AVR [HR: 0.36 (0.19-0.65), p = 0.0008]. There was no significant interaction of AVR and rhythm (p = 0.57).ConclusionsLower forward flow, right ventricular systolic dysfunction, and mitral regurgitation identified increased risk of subsequent mortality in asymptomatic patients with AF and AS. Additional studies of risk stratification of asymptomatic AS in AF vs. SR are needed.

Dataset Information

The impact of atrial fibrillation on prognosis in aortic stenosis.

Background

Objective

Methods

Results

Conclusion

Publications

The impact of atrial fibrillation on prognosis in aortic stenosis.

Similar Datasets

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