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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Cardiovascular Ultrasound 1/2012

Atrial fibrillation in aortic stenosis - echocardiographic assessment and prognostic importance

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2012
Autoren:
Charlotte Burup Kristensen, Jan Skov Jensen, Peter Sogaard, Helle Gervig Carstensen, Rasmus Mogelvang
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-10-38) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CBK performed the analysis of the echocardiographic material, interpreted the data and drafted the manuscript. RM performed the statistical analysis. RM, JSJ, PS and HGC added clinical discussion to the manuscript and contributed to analysis, interpretation and presentation of data. All authors read and approved the final manuscript.

Abstract

Background

Atrial 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.

Aim

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

Methods

The 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.

Results

Compared 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.

Conclusions

AFib 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.
Zusatzmaterial
Additional file 1: Video 1. Atrial fibrillation. Parasternal long-axis view.Case and control (77 year, male, severe aortic stenosis). The same patientsused as example in Figures 1 and 2. The patient with atrial fibrillationdied of heart failure after 2.2 years of follow up and the patient in sinusrhythm was still alive after maximal follow up of 4.3 years. (MOV 113 KB)
Authors’ original file for figure 1
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Authors’ original file for figure 2
12947_2012_438_MOESM4_ESM.jpeg
Authors’ original file for figure 3
12947_2012_438_MOESM5_ESM.jpeg
Literatur
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