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. 2023 Dec 22;9(8):778-784.
doi: 10.1093/ehjqcco/qcad004.

The impact of atrial fibrillation on prognosis in aortic stenosis

Dorien Laenens  1 , Jan Stassen  1 , Xavier Galloo  1 , See Hooi Ewe  2 , Gurpreet K Singh  1 , Mohammed R Ammanullah  2 , Kensuke Hirasawa  1 , Ching-Hui Sia  3 , Steele C Butcher  1   4 , Nicholas W S Chew  3 , William K F Kong  3 , Kian Keong Poh  3 , Zee P Ding  2 , Nina Ajmone Marsan  1 , Jeroen J Bax  1   5
Affiliations

The impact of atrial fibrillation on prognosis in aortic stenosis

Dorien Laenens et al. Eur Heart J Qual Care Clin Outcomes. .

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.

Keywords: Aortic stenosis; Atrial fibrillation; Diastolic dysfunction; prognosis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Patient selection. MVR = mitral valve replacement; LVOT = left ventricular outflow tract; MS = mitral stenosis; MR = mitral regurgitation.
Figure 2
Figure 2
Kaplan–Meier curve for all-cause mortality.
See this image and copyright information in PMC

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