Duke University Medical Center, Durham, NC
Duke Clinical Research Institute, Durham, NC.
J Am Heart Assoc. 2017 Dec 22;6(12):e006475. doi: 10.1161/JAHA.117.006475.
The presence of valvular heart disease (VHD) may affect the risk of stroke and mortality in patients with atrial fibrillation (AF). Community-based estimates of prevalence and outcomes of specific forms of VHD in patients with AF are lacking.
We examined the prevalence of VHD, anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with AF. Significant VHD was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between VHD groups and outcomes. Among 9748 patients with AF, 2705 (27.7%) had significant VHD. Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant VHD, individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07-1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant VHD. Patients with AF and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08-1.62).
Significant VHD is common among patients with AF in community practice. In a community cohort of patients with AF and CHADS-VASc score ≥2, most were anticoagulated. Individuals with AF and moderate-to-severe biological VHD have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant VHD.
心脏瓣膜病（VHD）的存在可能会影响房颤（AF）患者的中风和死亡率风险。缺乏关于 AF 患者特定类型 VHD 的患病率和结局的社区基础估计。
我们检查了 AF 患者社区队列中 VHD、抗凝治疗使用、死亡率、中风/短暂性脑缺血发作和出血的患病率。显著的 VHD 定义如下：（1）中度/重度二尖瓣狭窄或机械瓣膜；（2）生物瓣膜、手术修复或球囊瓣膜成形术；（3）中度/重度主动脉瓣反流或狭窄、二尖瓣反流或三尖瓣反流。使用比例风险模型检验 VHD 组与结局之间的关联。在 9748 例 AF 患者中，2705 例（27.7%）有显著的 VHD。在二尖瓣狭窄/机械瓣膜患者中，抗凝治疗使用率最高（91.8%）。与无显著 VHD 的个体相比，主动脉瓣反流/主动脉瓣狭窄、二尖瓣反流或三尖瓣反流的个体死亡风险最高（风险比，1.23；95%置信区间，1.07-1.42）。在有和没有显著 VHD 的个体中，中风或短暂性脑缺血发作和主要出血没有差异。AF 和主动脉瓣狭窄患者的死亡风险最高（风险比，1.32；95%置信区间，1.08-1.62）。
在社区实践中，AF 患者中显著的 VHD 很常见。在 AF 和 CHADS-VASc 评分≥2 的社区患者队列中，大多数患者接受了抗凝治疗。患有中度至重度生物性 VHD 的 AF 患者有更多的合并症和更高的死亡率风险；然而，在有和没有显著 VHD 的患者中，中风和大出血相似。
