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Prognosis of low-flow low-gradient aortic valve stenosis with atrial fibrillation

Ryo Nishinarita1, Jun Oikawa2, Kenshiro Arao1

  • 1Department of Cardiovascular Medicine, Nerima Hikarigaoka Hospital, Nerima, Japan.

Journal of Cardiology
|April 4, 2025
PubMed

Insights

Patients with low-flow low-gradient aortic valve stenosis and atrial fibrillation face a higher risk of heart failure. Atrial fibrillation is an independent predictor of worsening heart failure in this population.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Heart Failure Research

Background:

  • The prognosis for patients with low-flow low-gradient aortic valve stenosis (LFLG AS) is debated.
  • Atrial fibrillation (AF) is a known factor in low-flow status for severe AS (SAS).
  • The link between AF and heart failure (HF) risk in LFLG AS is not well understood.

Purpose of the Study:

  • To investigate the association between concomitant atrial fibrillation (AF) and the risk of worsening heart failure (HF) in patients with low-flow low-gradient aortic valve stenosis (LFLG AS).
  • To compare the risk of HF worsening in LFLG AS patients with and without AF against high-gradient AS (HG SAS) patients.

Main Methods:

  • Evaluated 278 patients with severe AS (SAS), categorizing them into high-gradient (HG) and low-flow low-gradient (LFLG) AS groups.
  • Subdivided groups based on the presence or absence of atrial fibrillation (AF).
  • Primary endpoint: worsening HF requiring hospitalization or specific drug therapy.

Main Results:

  • Worsening HF observed in 65 patients.
  • LFLG AS with AF showed a significantly higher rate of HF worsening compared to HG SAS without AF.
  • AF was identified as an independent predictor for worsening HF in LFLG AS patients (HR: 2.79; p=0.021).

Conclusions:

  • Patients with LFLG AS and concurrent AF have an unfavorable prognosis regarding HF.
  • The rate of HF worsening in LFLG AS with AF is comparable to that in HG SAS with AF.
  • Concomitant AF significantly increases the risk of worsening HF in LFLG AS patients.
Abstract

Keywords:
Atrial fibrillationHeart failureLow-flow low-gradient aortic valve stenosis

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