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Cardiovascular Ultrasound

, 10:38

First Online: 25 September 2012Received: 04 May 2012Accepted: 18 September 2012

Abstract

BackgroundAtrial fibrillation AFib exists more frequently in patients with aortic stenosis AS than in patients without, and AFib may be a sign of progressive deterioration of AS. Echocardiographic assessment of AS in sinus rhythm is well documented, however, little is known about AFib in AS since such patients often are excluded from clinical echocardiographic trials.

AimThe purpose of this study was to assess the prognostic importance of AFib in AS.

MethodsThe study was designed as a single-center case-control study. Patients with AS and AFib were enrolled as cases n = 103 and subsequently matched to controls 103 patients with AS but sinus rhythm. Cases and controls were matched according to age, gender and severity of AS. Primary outcome was all cause mortality and follow-up was 100% complete.

ResultsCompared to controls the group with AFib had lower mean ejection fraction 42% vs. 49%; p < 0.001 and stroke volume 47 mL vs. 55 mL; p = 0.004, but higher heart rate 81 bpm vs. 68 bpm; p < 0.001 and no significant difference with regard to cardiac output 3.8 L vs. 4.0 L; p = 0.29. Accordingly, aortic jet velocity and gradients were significantly lower in AFib compared to controls but there were no differences p = 0.38 in aortic valve area calculated by the continuity equation. During a median follow-up of 2.3 years IQR: 1.2-3.6, 70 34% patients with AS died: 42 patients with AFib and 28 patients with sinus rhythm p < 0.02. After adjusting for echocardiographic significant differences, AFib remained an independent predictor of mortality HR 2.72 95% CI: 1.12–6.61, p < 0.03. There was no significant interaction p = 0.62 between AFib and AS on the risk of mortality, indicating that AFib predicted bad outcome regardless of the severity of AS.

ConclusionsAFib is an independent risk factor in patients with AS and the prognostic impact of AFib seems to be the same despite the severity of AS.

KeywordsAortic stenosis Atrial fibrillation Echocardiography Mortality AbbreviationsASAortic Stenosis

AVAAortic Valve Area

AFibAtrial Fibrillation

BSABody Surface Area

EuroSCOREEuropean System for Cardiac Operative Risk Evaluation

LVLeft Ventricular

LVOTLeft Ventricular Outflow Tract

LVEFLeft Ventricular Ejection Fraction

SRSinus Rhythm.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-7120-10-38 contains supplementary material, which is available to authorized users.

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Author: Charlotte Burup Kristensen - Jan Skov Jensen - Peter Sogaard - Helle Gervig Carstensen - Rasmus Mogelvang

Source: https://link.springer.com/article/10.1186/1476-7120-10-38







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