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The impact of atrial fibrillation on prognosis in aortic stenosis

Dorien Laenens1, Jan Stassen1, Xavier Galloo1

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.

European Heart Journal. Quality of Care & Clinical Outcomes
|January 20, 2023
PubMed

Insights

Atrial fibrillation (AF) in patients with aortic stenosis (AS) is linked to reduced survival. However, this association disappears when accounting for left ventricular diastolic function, suggesting diastolic function is a key factor.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Prognostics

Background:

  • Atrial fibrillation (AF) and aortic stenosis (AS) frequently coexist in patients.
  • While AF's prognostic value in AS is studied, left ventricular (LV) diastolic function's role is less explored.

Purpose of the Study:

  • To assess the prognostic impact of AF in patients with AS.
  • To adjust for LV diastolic function when evaluating AF's effect on outcomes.

Main Methods:

  • Patients with newly diagnosed significant AS were categorized by AF history.
  • All-cause mortality was the primary endpoint, analyzed using Cox regression.
  • LV diastolic function parameters (indexed left atrial volume, E/e') were used for adjustment.

Main Results:

  • The study included 2849 AS patients (24.1% with AF history).
  • Ten-year mortality was higher in patients with AF (46.8%) versus sinus rhythm (36.8%).
  • AF was independently associated with mortality but lost significance after correcting for LV diastolic function markers.

Conclusions:

  • Patients with AS and AF exhibit decreased survival compared to those in sinus rhythm.
  • LV diastolic function markers (indexed left atrial volume, E/e') mediate the prognostic impact of AF in AS.
  • AF is not an independent predictor of mortality in AS when LV diastolic function is considered.
Abstract

Keywords:
Aortic stenosisAtrial fibrillationDiastolic dysfunctionprognosis

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