PMID- 37408654
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230718
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 10
DP  - 2023
TI  - Impact of atrial fibrillation on outcomes in asymptomatic severe aortic stenosis: 
      a propensity-matched analysis.
PG  - 1195123
LID - 10.3389/fcvm.2023.1195123 [doi]
LID - 1195123
AB  - BACKGROUND: Atrial fibrillation (AF) portends poor prognosis in patients with 
      aortic stenosis (AS). OBJECTIVES: This study aimed to study the association of AF 
      vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine 
      clinical practice. METHODS: We identified 909 asymptomatic patients from 3,208 
      consecutive patients with aortic valve area </=1.0 cm(2) and left ventricular 
      ejection fraction >/=50% at a tertiary academic center. Patients were grouped by 
      rhythm at the time of transthoracic echocardiogram [SR: 820/909 (90%) and AF: 
      89/909 (10%)]. Propensity-matched analyses (2 SR:1 AF) matching 174 SR to 89 AF 
      patients by age, sex, and clinical comorbidities were used to compare outcomes. 
      RESULTS: In the propensity-matched cohort, median age (82 +/- 8 vs. 81 +/- 9 years, 
      p = 0.31), sex distribution (male 58% vs. 52%, p = 0.30), and Charlson 
      comorbidity index (4.0 vs. 3.0, p = 0.26) were not different in AF vs. SR. Median 
      follow-up duration was 2.6 (IQR: 1.0-4.4) years. The 1-year rate of aortic valve 
      replacement (AVR) was not different (AF: 32% vs. SR: 37%, p = 0.31). All-cause 
      mortality was higher in AF [hazard ratio (HR): 1.68 (1.13-2.50), p = 0.009]. 
      Independent predictors of mortality were age [HR: 1.92 (1.40-2.62), p < 0.001], 
      Charlson comorbidity index [1.09 (1.03-1.15), p = 0.002], aortic valve peak 
      velocity [HR: 1.87 (1.20-2.94), p = 0.006], stroke volume index [HR: 0.75 
      (0.60-0.93), p = 0.01], moderate or more mitral regurgitation [HR: 2.97 
      (1.43-6.19), p = 0.004], right ventricular systolic dysfunction [HR: 2.39 
      (1.29-4.43), p = 0.006], and time-dependent AVR [HR: 0.36 (0.19-0.65), 
      p = 0.0008]. There was no significant interaction of AVR and rhythm (p = 0.57). 
      CONCLUSIONS: Lower forward flow, right ventricular systolic dysfunction, and 
      mitral regurgitation identified increased risk of subsequent mortality in 
      asymptomatic patients with AF and AS. Additional studies of risk stratification 
      of asymptomatic AS in AF vs. SR are needed.
CI  - (c) 2023 Oguz, Huntley, El-Am, Scott, Thaden, Pislaru, Fabre, Singh, Greason, 
      Crestanello, Pellikka, Oh and Nkomo.
FAU - Oguz, Didem
AU  - Oguz D
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Huntley, Geoffrey D
AU  - Huntley GD
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - El-Am, Edward A
AU  - El-Am EA
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Scott, Christopher G
AU  - Scott CG
AD  - Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
FAU - Thaden, Jeremy J
AU  - Thaden JJ
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Pislaru, Sorin V
AU  - Pislaru SV
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Fabre, Katarina L
AU  - Fabre KL
AD  - Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Singh, Mandeep
AU  - Singh M
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Greason, Kevin L
AU  - Greason KL
AD  - Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States.
FAU - Crestanello, Juan A
AU  - Crestanello JA
AD  - Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States.
FAU - Pellikka, Patricia A
AU  - Pellikka PA
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Oh, Jae K
AU  - Oh JK
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
FAU - Nkomo, Vuyisile T
AU  - Nkomo VT
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
LA  - eng
PT  - Journal Article
DEP - 20230620
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC10318187
OTO - NOTNLM
OT  - aortic stenosis
OT  - asymptomatic
OT  - atrial fibrillation
OT  - mitral regurgitation
OT  - right ventricle dysfunction
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/07/06 06:42
MHDA- 2023/07/06 06:43
PMCR- 2023/01/01
CRDT- 2023/07/06 04:00
PHST- 2023/03/28 00:00 [received]
PHST- 2023/06/05 00:00 [accepted]
PHST- 2023/07/06 06:43 [medline]
PHST- 2023/07/06 06:42 [pubmed]
PHST- 2023/07/06 04:00 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2023.1195123 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2023 Jun 20;10:1195123. doi: 10.3389/fcvm.2023.1195123. 
      eCollection 2023.