PMID- 31439661 OWN - NLM STAT- MEDLINE DCOM- 20201016 LR - 20201016 IS - 1468-201X (Electronic) IS - 1355-6037 (Print) IS - 1355-6037 (Linking) VI - 106 IP - 4 DP - 2020 Feb TI - Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis. PG - 280-286 LID - 10.1136/heartjnl-2019-314996 [doi] AB - OBJECTIVES: To examine the prognostic significance of atrial fibrillation (AF) versus sinus rhythm (SR) on the management and outcomes of patients with severe aortic stenosis (AS). METHODS: 1847 consecutive patients with severe AS (aortic valve area /=40 mm Hg or peak velocity >/=4 m/s) and left ventricular ejection fraction >/=50% were identified. The independent association of AF and all-cause mortality was assessed. RESULTS: Age was 76+/-11 years and 46% were female; 293 (16%) patients had AF and 1554 (84%) had SR. In AF, 72% were symptomatic versus 71% in SR. Survival rate at 5 years for AF (41%) was lower than SR (65%) (age- and sex-adjusted HR=1.66 (1.40-1.98), p<0.0001). In multivariable analysis, factors associated with mortality included age (HR per 10 years=1.55 (1.42-1.69), p<0.0001), dyspnoea (HR=1.58 (1.33-1.87), p<0.0001), >/= moderate mitral regurgitation (HR=1.63 (1.22-2.18), p=0.001), right ventricular systolic dysfunction (HR=1.88 (1.52-2.33), p<0.0001), left atrial volume index (HR per 10 mL/m(2)=1.13 (1.07-1.19), p<0.0001) and aortic valve replacement (AVR) (HR=0.44 (0.38-0.52), p<0.0001). AF was not a predictor of mortality independent of variables strongly correlated HR=1.02 (0.84-1.25), p=0.81). The 1-year probability of AVR following diagnosis of severe AS was lower in AF (49.8%) than SR (62.5%) (HR=0.73 (0.62-0.86), p<0.001); among patients with AF not referred for AVR, symptoms were frequently attributed to AF instead of AS. CONCLUSION: AF was associated with poor prognosis in patients with severe AS, but apparent differences in outcomes compared with SR were explained by factors other than AF including concomitant cardiac abnormalities and deferral of AVR due to attribution of cardiac symptoms to AF. CI - (c) Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Zhang, Hongju AU - Zhang H AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - El-Am, Edward A AU - El-Am EA AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Thaden, Jeremy J AU - Thaden JJ AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Pislaru, Sorin V AU - Pislaru SV AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Scott, Christopher G AU - Scott CG AUID- ORCID: 0000-0003-1340-0647 AD - Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States. FAU - Krittanawong, Chayakrit AU - Krittanawong C AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Chahal, Anwar A AU - Chahal AA AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Breen, Thomas J AU - Breen TJ AD - Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Eleid, Mackram F AU - Eleid MF AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Melduni, Rowlens M AU - Melduni RM AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Greason, Kevin L AU - Greason KL AD - Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, United States. FAU - McCully, Robert B AU - McCully RB AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Enriquez-Sarano, Maurice AU - Enriquez-Sarano M AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Oh, Jae K AU - Oh JK AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Pellikka, Patricia A AU - Pellikka PA AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States. FAU - Nkomo, Vuyisile T AU - Nkomo VT AUID- ORCID: 0000-0001-6095-5579 AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States nkomo.vuyisile@mayo.edu. LA - eng GR - K01 HL135288/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20190822 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Aortic Valve Stenosis/diagnostic imaging/epidemiology/*therapy MH - Atrial Fibrillation/*epidemiology MH - Bioprosthesis MH - Cardiovascular Diseases/mortality MH - Cause of Death MH - Comorbidity MH - Conservative Treatment MH - Dyspnea/epidemiology MH - Echocardiography, Doppler MH - Female MH - Heart Failure/epidemiology MH - Heart Valve Prosthesis MH - Heart Valve Prosthesis Implantation/*statistics & numerical data MH - Humans MH - Male MH - Mitral Valve Insufficiency/epidemiology MH - *Mortality MH - Prognosis MH - Proportional Hazards Models MH - Renal Insufficiency/epidemiology MH - Severity of Illness Index MH - Stroke Volume MH - Transcatheter Aortic Valve Replacement/statistics & numerical data MH - Ventricular Dysfunction, Right/epidemiology PMC - PMC6989366 MID - NIHMS1057244 OTO - NOTNLM OT - aortic stenosis OT - aortic valve replacement OT - atrial fibrillation OT - mortality OT - natural history OT - prognosis COIS- Competing interests: None declared. EDAT- 2019/08/24 06:00 MHDA- 2020/10/21 06:00 PMCR- 2020/02/01 CRDT- 2019/08/24 06:00 PHST- 2019/02/27 00:00 [received] PHST- 2019/07/21 00:00 [revised] PHST- 2019/07/22 00:00 [accepted] PHST- 2019/08/24 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] PHST- 2019/08/24 06:00 [entrez] PHST- 2020/02/01 00:00 [pmc-release] AID - heartjnl-2019-314996 [pii] AID - 10.1136/heartjnl-2019-314996 [doi] PST - ppublish SO - Heart. 2020 Feb;106(4):280-286. doi: 10.1136/heartjnl-2019-314996. Epub 2019 Aug 22.