Valvular Heart DiseasePrognostic Significance of Atrial Fibrillation and Severity of Symptoms of Heart Failure in Patients With Low Gradient Aortic Stenosis and Preserved Left Ventricular Ejection Fraction
Section snippets
Methods
We analyzed our database to evaluate clinical, echocardiographic, and biohumoral data from patients with LG AS despite normal LVEF observed in our department from January 2005 to December 2010. Inclusion criteria were (1) aortic valve area (AVA; measured by the continuity equation) <1.0 cm2, (2) mean gradient (MG) ≤30 mm Hg, and (3) LVEF ≥55%. We arbitrarily decided to adopt strict enrollment criteria to minimize the burden of measurement errors. Moreover, for the same reason, the inclusion
Results
Over the considered 5-year period of analysis, within the cohort of 1,149 consecutive patients with severe AS (AVA <1 cm2) observed in the echocardiography laboratory of our department, we retrospectively identified 397 patients (35%) with LG (≤30 mm Hg); among this group, we included 167 patients (15%) with LG AS and normal LVEF (≥55%), matching the above-mentioned enrollment criteria (see Figure 1).
Complete baseline clinical and laboratory data are listed in Table 1. The median age of our
Discussion
With the present study, we proposed to carry out a comprehensive clinical and echocardiographic analysis of a large cohort of patients with LG AS despite normal LVEF, to better understand prognostic factors and therapeutic strategies in this difficult subset. The enrollment and exclusion criteria we arbitrarily decided to adopt were aimed to eliminate possible confounding factors (e.g., LVEF 50% to 54%, MG 31 to 39 mm Hg) but, at the same time, to obtain a population that is intended to be
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (22)
Late incidence and recurrence of new-onset atrial fibrillation after isolated surgical aortic valve replacement
2022, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :These factors can cause a complex array of pathophysiological changes in the atria, which enhances ectopy and conduction disturbances, increasing the likelihood to develop or maintain AF.26 Valvular heart disease also is an independent risk factor for AF27; a registry of patients with AF across 9 European countries showed that any valvular heart disease coexisted in 63.5% of AF patients.28 Besides individual susceptibility and valvular heart disease, there might be other unknown factors contributing to AF, which could also play a role in the development of AF during the index hospitalization and after discharge.
Impact of Surgical and Transcatheter Aortic Valve Replacement in Low-Gradient Aortic Stenosis: A Meta-Analysis
2021, JACC: Cardiovascular InterventionsCitation Excerpt :Proper ethical approval was obtained in the context of each of the included studies. After screening for eligibility, 32 studies with a total of 6,515 patients (1,769 with classical LF-LG AS, 809 with paradoxical LF-LG AS, 1,468 with NF-LG AS, and 4,746 with LG AS with preserved LVEF) were included for meta-analysis (Figure 1) (5,13–43). All studies were observational except that of Herrmann et al. (22), a post hoc analysis of the PARTNER (Placement of Transcatheter Aortic Valve) trial.
Impact of Atrial Fibrillation in Aortic Stenosis (From the United States Readmissions Database)
2021, American Journal of CardiologyDifferences in Clinical and Echocardiographic Profiles and Outcomes of Patients With Atrial Fibrillation Versus Sinus Rhythm in Medically Managed Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction
2020, Heart Lung and CirculationCitation Excerpt :Our findings of medically-managed patients with AS with long-term follow-up portrayed the prognostic impact of concomitant AF in this population. Our study population's baseline characteristics were consistent with other studies, where patients tended to have advanced age and significant comorbidities [13]. The rising incidence of AF with increasing age makes it an important comorbidity to study in a chronic disease setting of severe AS [14].
Clinical and Echocardiographic Predictors of Outcomes in Patients With Moderate (Mean Transvalvular Gradient 20 to 40 mm Hg) Aortic Stenosis
2019, American Journal of CardiologyCitation Excerpt :Atrial fibrillation is common in patients with AS and occurs more frequently as AS severity increases.6 In patients with severe AS, it has been shown to be a predictor of mortality, even in those who are asymptomatic.7,8 In this study, atrial fibrillation was present in 20% of patients and was significantly associated with both composite outcomes.
Predicting Outcomes in Patients With AsymptomaticModerate to Severe Aortic Stenosis
2018, American Journal of CardiologyCitation Excerpt :Since LA size is related to both LV diastolic dysfunction and AF, it is likely a surrogate for these parameters. AF in patients with AS is a risk marker for increased cardiovascular mortality.24,25 Our data showed it is also a risk marker for both AVR and HF in asymptomatic patients.
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