Link between AF and mortality in severe aortic stenosis attenuated by LV function
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Atrial fibrillation was associated with mortality in patients with significant aortic stenosis, but correction for left ventricular diastolic function rendered the association not significant, researchers reported.
“AF is the predominant sustained arrhythmia in the general population with a prevalence of 0.5% to 1%. However, in patients with severe aortic stenosis, AF is present in 15% and up to 50% in patients undergoing transcatheter aortic valve replacement. Various studies have highlighted the prognostic value of AF in patients with aortic stenosis, with conflicting results,” Dorien Laenens, MD, cardiologist at Leiden University Medical Center in the Netherlands, and colleagues wrote. “It is well known that significant aortic stenosis induces pressure overload, which leads to adverse left ventricular remodeling. An increased afterload is associated with LV hypertrophy, LV diastolic dysfunction, increased LV filling pressures and subsequent left atrial (LA) dilatation, which ultimately might cause AF.”
To better understand whether AF is an epiphenomenon of cardiac remodeling due to aortic stenosis or has independent prognostic value, Laenens and colleagues evaluated data from a multicenter registry of 2,849 adult patients with significant aortic stenosis in the Netherlands and Singapore (mean age, 72 years; 55% men; 24% with history of AF). Significant aortic stenosis was defined as an aortic valve area 1.5 cm or less.
The study was published in European Heart Journal – Quality of Care and Clinical Outcomes.
During a median follow-up of 60 months, 41.5% of patients died.
Among those with significant aortic stenosis, compared with patients with sinus rhythm, 10-year mortality was higher in patients with AF (46.8% vs. 36.8%; log-rank P < .001).
After multivariable Cox regression analysis, AF was observed to be an independent risk factor for all-cause mortality in patients with significant aortic stenosis (HR = 1.19; 95% CI, 1.02-1.38; P = .026); however, the association was attenuated after correction for measures of LV diastolic function including indexed left atrial volume, E/e’ or both (HR when corrected for both = 1.04; 95% CI, 0.87-1.26; P = .66).
“This large retrospective analysis of patients with significant aortic stenosis reveals that AF is not a prognostic marker once the patient population is adjusted for LV diastolic function,” the researchers wrote. “Although patients in the AF group have reduced overall survival as compared to patients in the sinus rhythm group, AF was not independently associated with outcomes. Moreover, AF reflects underlying LV diastolic dysfunction and should raise awareness of more pronounced adverse cardiac remodeling induced by significant aortic stenosis.”
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