TY - JOUR
T1 - Impact of atrial fibrillation on outcomes in asymptomatic severe aortic stenosis
T2 - a propensity-matched analysis
AU - Oguz, Didem
AU - Huntley, Geoffrey D.
AU - El-Am, Edward A.
AU - Scott, Christopher G.
AU - Thaden, Jeremy J.
AU - Pislaru, Sorin V.
AU - Fabre, Katarina L.
AU - Singh, Mandeep
AU - Greason, Kevin L.
AU - Crestanello, Juan A.
AU - Pellikka, Patricia A.
AU - Oh, Jae K.
AU - Nkomo, Vuyisile T.
N1 - Publisher Copyright:
2023 Oguz, Huntley, El-Am, Scott, Thaden, Pislaru, Fabre, Singh, Greason, Crestanello, Pellikka, Oh and Nkomo.
PY - 2023
Y1 - 2023
N2 - Background: Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS). Objectives: This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice. Methods: We 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. Results: In 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). Conclusions: Lower 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.
AB - Background: Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS). Objectives: This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice. Methods: We 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. Results: In 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). Conclusions: Lower 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.
KW - aortic stenosis
KW - asymptomatic
KW - atrial fibrillation
KW - mitral regurgitation
KW - right ventricle dysfunction
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U2 - 10.3389/fcvm.2023.1195123
DO - 10.3389/fcvm.2023.1195123
M3 - Article
AN - SCOPUS:85164508328
SN - 2297-055X
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1195123
ER -