Key result
AF in significant AS links to ~19% higher mortality but not independently of LV diastolic function.
Why the study?
Studies assessing the prognostic value of AF in patients with AS have rarely accounted for LV diastolic function.
Does a history of atrial fibrillation independently increase all-cause mortality in patients with significant aortic stenosis when correcting for LV diastolic function?
Cohort (n=2,849)
Does a history of atrial fibrillation independently increase all-cause mortality in patients with significant aortic stenosis when correcting for LV diastolic function?
Hazard Ratio: 1.19 (95% CI 1.02–1.38)
Absolute Event Rate: 46.8% vs 36.8%
p-value: p=0.026
While atrial fibrillation is associated with reduced survival in patients with significant aortic stenosis, this effect appears to be driven by underlying LV diastolic dysfunction rather than the arrhythmia itself.
AF-mortality association in aortic stenosis attenuates after diastolic adjustment; leaves open whether rhythm control modifies outcomes beyond diastolic function.
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.
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Laenens et al. (2023) conducted a cohort in Significant aortic stenosis (n=2,849). Atrial fibrillation vs. Sinus rhythm was evaluated on All-cause mortality (HR 1.19, 95% CI 1.02-1.38, p=0.026). Atrial fibrillation in patients with significant aortic stenosis was associated with higher 10-year mortality (46.8% vs 36.8%), but not independently when correcting for LV diastolic function.
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