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Disproportionately high aortic valve calcium scores in atrial fibrillation: implications for transcatheter aortic

Rajeev Masson1, Vuyisile T Nkomo2, David R Holmes2

  • 1Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.

European Heart Journal. Cardiovascular Imaging
|April 26, 2024
PubMed

Insights

Patients with atrial fibrillation (AF) had more severe aortic stenosis (AS) and worse outcomes after transcatheter aortic valve replacement (TAVR) compared to those in sinus rhythm (SR). This suggests AS severity is underestimated in AF patients, potentially delaying TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Doppler mean gradient (MG) may underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) versus sinus rhythm (SR).
  • This underestimation can potentially delay timely intervention in AF patients.
  • Transcatheter aortic valve replacement (TAVR) is a key treatment for severe AS.

Purpose of the Study:

  • To compare outcomes in patients with AF and SR following TAVR.
  • To investigate potential delays in TAVR referral for AF patients using computed tomography aortic valve calcium score (AVCS).

Main Methods:

  • Retrospective analysis of 820 patients undergoing TAVR for severe AS (2013-2017).
  • Comparison of baseline characteristics, AVCS, and overall survival between AF and SR groups.
  • Statistical analysis to identify factors associated with mortality post-TAVR.

Main Results:

  • Patients with AF (n=356) were older and had lower MG but similar indexed aortic valve area compared to SR patients.
  • Median AVCS was significantly higher in AF patients (males P=0.044, females P=0.025).
  • Median survival post-TAVR was worse in AF patients (3.2 years) compared to SR patients (5.4 years), with AF being a significant predictor of mortality.

Conclusions:

  • Older age and higher AVCS in AF patients suggest AS was underestimated and more advanced at TAVR referral.
  • Atrial fibrillation is associated with worse outcomes after TAVR.
  • Current AS severity assessment may need adjustment for patients with AF.
Abstract

Keywords:
aortic valve calcium scoreaortic valve stenosisatrial fibrillationcardiovascular imagingechocardiographytranscatheter aortic valve replacement

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