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, Masaaki Nakase Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Search for other works by this author on: Oxford Academic Daijiro Tomii Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Dik Heg CTU Bern, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Fabien Praz Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Stefan Stortecky Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Jonas Lanz Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic David Reineke Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Stephan Windecker Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Search for other works by this author on: Oxford Academic Thomas Pilgrim Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland Corresponding author. Tel: +0041 31 632 21 11, Fax: +0041 31 632 47 70, Email: thomas.pilgrim@insel.ch Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0002-8766-7945 European Heart Journal - Quality of Care and Clinical Outcomes, Volume 10, Issue 3, April 2024, Pages 246–255, https://doi.org/10.1093/ehjqcco/qcad045
Published:
25 July 2023
Article history
Received:
05 April 2023
Revision received:
13 June 2023
Accepted:
24 July 2023
Published:
25 July 2023
Corrected and typeset:
02 August 2023
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Masaaki Nakase, Daijiro Tomii, Dik Heg, Fabien Praz, Stefan Stortecky, Jonas Lanz, David Reineke, Stephan Windecker, Thomas Pilgrim, Association of atrial fibrillation with survival in patients with low-flow low-gradient aortic stenosis with preserved ejection fraction undergoing TAVI, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 10, Issue 3, April 2024, Pages 246–255, https://doi.org/10.1093/ehjqcco/qcad045
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Abstract
Aims
There is limited evidence on the prognostic significance of atrial fibrillation (AF) in patients with low flow, low-gradient aortic stenosis with preserved ejection fraction (LFLG-pEF AS). We aimed to evaluate the recovery of stroke volume after transcatheter aortic valve implantation (TAVI) and clinical outcomes in patients with LFLG-pEF AS stratified by presence or absence of AF.
Methods and results
In a prospective TAVI registry, patients with preserved left ventricular ejection fraction (LVEF≥50%) were stratified according to flow-gradient status and presence of AF. Among 2259 TAVI patients with preserved LVEF between August 2007 and June 2021, 765 had high-gradient AS (HG AS) and 444 had LFLG-pEF AS. AF was observed in 199 patients with HG AS (26.0%) and 190 patients with LFLG-pEF AS (42.8%). At 1 year, stroke volume index (SVi) was significantly improved in LFLG-pEF AS patients without AF, while SVi remained low in patients with AF (from 25.9±8.5mL/m2 to 37.2±9.9mL/m2 and from 26.8±5.1mL/m2 to 26.1±9.1mL/m2, respectively). LFLG-pEF AS patients with AF had an increased risk of 1-year all-cause mortality compared with those without AF (adjusted hazard ratio (HRadjusted) 2.57; 95% confidence interval [CI] 1.44–4.59). LFLG-pEF AS patients without AF had similar mortality compared with HG AS patients without AF (HRadjusted 0.85; 95% CI 0.49–1.46).
Conclusion
Patients with LFLG-pEF AS and AF experienced no relevant recovery of stroke volume after TAVI, but a more than two-fold increased risk of death compared to patients with HG AS or LFLG-pEF AS without AF.
Clinical Trial Registration
https://www.clinicaltrials.gov. NCT01368250.
Graphical Abstract
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Aortic stenosis, Atrial fibrillation, Low flow, low-gradient aortic stenosis with preserved ejection fraction, Transcatheter aortic valve implantation
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Topic:
- aortic valve stenosis
- atrial fibrillation
- left ventricular ejection fraction
- peak expiratory flow rate measurement
- pefloxacin
- stroke volume
- mortality
- treatment outcome
- ejection fraction
- transcatheter aortic-valve implantation
- fluid flow
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