Key result
Atrial fibrillation linked to ~68% higher mortality versus sinus rhythm in asymptomatic severe aortic stenosis.
Why the study?
Atrial fibrillation portends poor prognosis in aortic stenosis, but its association with outcomes in asymptomatic severe aortic stenosis during routine clinical practice required study.
Does atrial fibrillation increase mortality in asymptomatic patients with severe aortic stenosis compared to sinus rhythm?
Cohort (n=909)
No
Does atrial fibrillation increase mortality in asymptomatic patients with severe aortic stenosis compared to sinus rhythm?
Effect estimate: HR 1.68 (95% CI 1.13-2.50)
p-value: p=0.009
Atrial fibrillation is associated with increased all-cause mortality in asymptomatic patients with severe aortic stenosis, highlighting the need for careful risk stratification in this population.
AF associated with higher mortality in asymptomatic severe AS; leaves open whether rhythm control improves outcomes.
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 cm 2 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.
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Oğuz et al. (2023) conducted a cohort in Asymptomatic severe aortic stenosis (n=909). Atrial fibrillation vs. Sinus rhythm was evaluated on All-cause mortality (HR 1.68, 95% CI 1.13-2.50, p=0.009). Atrial fibrillation was associated with a significantly higher risk of all-cause mortality (HR 1.68) compared to sinus rhythm in patients with asymptomatic severe aortic stenosis.
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