Oguz Didem, Huntley Geoffrey D, El-Am Edward A, Scott Christopher G, Thaden Jeremy J, Pislaru Sorin V, Fabre Katarina L, Singh Mandeep, Greason Kevin L, Crestanello Juan A, Pellikka Patricia A, Oh Jae K, Nkomo Vuyisile T
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
Front Cardiovasc Med. 2023 Jun 20;10:1195123. doi: 10.3389/fcvm.2023.1195123. eCollection 2023.
Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS).
This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice.
We identified 909 asymptomatic patients from 3,208 consecutive patients with aortic valve area ≤1.0 cm 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.
In the propensity-matched cohort, median age (82 ± 8 vs. 81 ± 9 years, = 0.31), sex distribution (male 58% vs. 52%, = 0.30), and Charlson comorbidity index (4.0 vs. 3.0, = 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%, = 0.31). All-cause mortality was higher in AF [hazard ratio (HR): 1.68 (1.13-2.50), = 0.009]. Independent predictors of mortality were age [HR: 1.92 (1.40-2.62), < 0.001], Charlson comorbidity index [1.09 (1.03-1.15), = 0.002], aortic valve peak velocity [HR: 1.87 (1.20-2.94), = 0.006], stroke volume index [HR: 0.75 (0.60-0.93), = 0.01], moderate or more mitral regurgitation [HR: 2.97 (1.43-6.19), = 0.004], right ventricular systolic dysfunction [HR: 2.39 (1.29-4.43), = 0.006], and time-dependent AVR [HR: 0.36 (0.19-0.65), = 0.0008]. There was no significant interaction of AVR and rhythm ( = 0.57).
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.
心房颤动（AF）预示着主动脉瓣狭窄（AS）患者的预后不良。
本研究旨在探讨在常规临床实践中，AF与窦性心律（SR）对无症状重度AS患者预后的影响。
我们在一家三级学术中心的3208例连续患者中，识别出909例主动脉瓣面积≤1.0 cm且左心室射血分数≥50%的无症状患者。根据经胸超声心动图检查时的心律将患者分组[SR：820/909（90%），AF：89/909（10%）]。采用倾向评分匹配分析（2例SR：1例AF），根据年龄、性别和临床合并症将174例SR患者与89例AF患者进行匹配，以比较预后。
在倾向评分匹配队列中，AF组与SR组的中位年龄（82±8岁对81±9岁，P=0.31）、性别分布（男性58%对52%，P=0.30）和Charlson合并症指数（4.0对3.0，P=0.26）无差异。中位随访时间为2.6（四分位间距：1.0 - 4.4）年。主动脉瓣置换术（AVR）的1年发生率无差异（AF：32%对SR：37%，P=0.31）。AF组的全因死亡率更高[风险比（HR）：1.68（1.13 - 2.50），P=0.009]。死亡率的独立预测因素包括年龄[HR：1.92（1.40 - 2.62），P<0.001]、Charlson合并症指数[1.09（1.03 - 1.15），P=0.002]、主动脉瓣峰值流速[HR：1.87（1.20 - 2.94），P=0.006]、每搏量指数[HR：0.75（0.60 - 0.93），P=0.01]、中度或更严重的二尖瓣反流[HR：2.97（1.43 - 6.19），P=0.004]、右心室收缩功能障碍[HR：2.39（1.29 - 4.43），P=0.006]以及时间依赖性AVR[HR：0.36（0.19 - 0.65），P=0.0008]。AVR与心律之间无显著交互作用（P=0.
