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Kim JS, Kim J, Kang Y, Sohn SH, Lee Y, Kim SH, Hwang HY, Kim KH, Kim MS, Choi JW. Clinical benefits of surgical ablation during isolated aortic valve replacement: a nationwide study. Eur J Cardiothorac Surg 2024; 65:ezae085. [PMID: 38447184 DOI: 10.1093/ejcts/ezae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/05/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES To compare the early- and long-term clinical outcomes of concomitant surgical ablation (SA) for atrial fibrillation (AF) during isolated aortic valve replacement (AVR) using data from the Korean National Health Insurance Service Database. METHODS Of 23,332 adult patients who underwent AVR between 2003 and 2019, those with underlying AF with or without concomitant SA were extracted, and propensity score matching analysis was performed. RESULTS Overall, 1,741 patients with underlying AF with (n = 445, group A) or without (n = 1,296, group N) concomitant SA during isolated AVR were enrolled, from whom 435 pairs were matched in a 1:1 ratio using propensity score matching analysis. The operative mortality and early postoperative morbidities, including bleeding reoperation, stroke, permanent pacemaker implantation and acute kidney injury were comparable between the groups. The overall survival showed no differences between the groups. However, the cumulative incidence of new-onset late ischaemic stroke was significantly lower in group A than group N in propensity score-matched patients [2.3 vs 3.5 per 100 patient-years, adjusted hazard ratio (95% confidence interval) 0.64 (0.43-0.96), Group A versus Group N, respectively]. The cumulative incidence of other morbidities such as reoperation, permanent pacemaker implantation and progression to chronic renal failure showed no difference between groups. CONCLUSIONS The incidence of late ischaemic stroke was significantly lower when concomitant SA was performed during isolated AVR in patients with underlying AF. Therefore, concomitant SA should be actively considered in patients with underlying AF undergoing isolated AVR to prevent the occurrence of late ischaemic stroke.
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Affiliation(s)
- Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Kim
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yewon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sue Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Je HG, Choi JW, Hwang HY, Kim HJ, Kim JB, Kim HJ, Choi JS, Jeong DS, Kwak JG, Park HK, Lee SH, Lim C, Lee JW. 2023 KASNet Guidelines on Atrial Fibrillation Surgery. J Chest Surg 2024; 57:1-24. [PMID: 37994091 DOI: 10.5090/jcs.23.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 11/24/2023] Open
Affiliation(s)
- Hyung Gon Je
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Departments of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Departments of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Won Lee
- Department of Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
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Laenens D, Stassen J, Galloo X, Ewe SH, Singh GK, Ammanullah MR, Hirasawa K, Sia CH, Butcher SC, Chew NWS, Kong WKF, Poh KK, Ding ZP, Ajmone Marsan N, Bax JJ. The impact of atrial fibrillation on prognosis in aortic stenosis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:778-784. [PMID: 36669758 PMCID: PMC10745267 DOI: 10.1093/ehjqcco/qcad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor. OBJECTIVE To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function. METHODS Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality. RESULTS In total, 2849 patients with significant AS (mean age 72 ± 12 years, 54.8% men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30-97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P < 0.001). On univariable (HR: 1.42; 95% CI: 1.25-1.62; P < 0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02-1.38; P = 0.026), AF was independently associated with mortality. However, when correcting for indexed left atrial volume, E/e' or both, AF was no longer independently associated with all-cause mortality. CONCLUSION Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.
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Affiliation(s)
- Dorien Laenens
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mohammed R Ammanullah
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA 6000, Australia
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Zee P Ding
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Turku Heart Center, University of Turku and Turku Unviersity Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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Kubala M, Bohbot Y, Rusinaru D, Maréchaux S, Diouf M, Tribouilloy C. Atrial fibrillation in severe aortic stenosis: Prognostic value and results of aortic valve replacement. J Thorac Cardiovasc Surg 2023; 166:771-779. [PMID: 34937660 DOI: 10.1016/j.jtcvs.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although atrial fibrillation (AF) is common, its impact on long-term mortality has not been reliably determined in patients with aortic stenosis (AS). We aimed to assess whether AF is associated with survival in patients with severe AS and to determine the impact of AF on the results of aortic valve replacement (AVR). METHODS The study included 1838 consecutive patients with severe AS (77 ± 11 years, male 47%). Upon AS diagnosis, patients were screened for AF using a 12-lead electrocardiogram. The treatment strategy (conservative management or AVR) was selected by the heart team in accordance with current guidelines. The effect of AVR on survival was analyzed as a time-dependent covariate using the entire follow-up period. RESULTS AF, diagnosed in 593 (32%) patients was associated with poor survival at 5 years (55 ± 2% vs 74 ± 1% for patients in sinus rhythm, P < .001), even after adjustment for established outcome predictors (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.33-1.84; P < .001). In patients with AF, AVR was associated with lower mortality (HR, 0.16; 95% CI, 0.12-0.22; P < .001) even in those with no or minimal symptoms (HR, 0.12; 95% CI, 0.08-0.20; P < .001). However, among patients who underwent AVR, those in AF had an excess mortality (HR, 1.59; 95% CI, 1.22-2.08; P < .001). CONCLUSIONS In severe AS, AF is a strong predictor of mortality even in asymptomatic or minimally symptomatic patients. After AVR, AF remains associated with poorer survival than sinus rhythm. In patients in AF, AVR is associated with lower mortality compared with conservative treatment. Further studies are needed to confirm the benefits of AVR in asymptomatic patients in AF with severe AS.
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Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Sylvestre Maréchaux
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France; Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Lille Nord de France, Lille, France
| | - Momar Diouf
- Department of Clinical Research, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
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Oguz D, Huntley GD, El-Am EA, Scott CG, Thaden JJ, Pislaru SV, Fabre KL, Singh M, Greason KL, Crestanello JA, Pellikka PA, Oh JK, Nkomo VT. Impact of atrial fibrillation on outcomes in asymptomatic severe aortic stenosis: a propensity-matched analysis. Front Cardiovasc Med 2023; 10:1195123. [PMID: 37408654 PMCID: PMC10318187 DOI: 10.3389/fcvm.2023.1195123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Background Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS). Objectives This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice. Methods We identified 909 asymptomatic patients from 3,208 consecutive patients with aortic valve area ≤1.0 cm2 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. Results In the propensity-matched cohort, median age (82 ± 8 vs. 81 ± 9 years, p = 0.31), sex distribution (male 58% vs. 52%, p = 0.30), and Charlson comorbidity index (4.0 vs. 3.0, p = 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%, p = 0.31). All-cause mortality was higher in AF [hazard ratio (HR): 1.68 (1.13-2.50), p = 0.009]. Independent predictors of mortality were age [HR: 1.92 (1.40-2.62), p < 0.001], Charlson comorbidity index [1.09 (1.03-1.15), p = 0.002], aortic valve peak velocity [HR: 1.87 (1.20-2.94), p = 0.006], stroke volume index [HR: 0.75 (0.60-0.93), p = 0.01], moderate or more mitral regurgitation [HR: 2.97 (1.43-6.19), p = 0.004], right ventricular systolic dysfunction [HR: 2.39 (1.29-4.43), p = 0.006], and time-dependent AVR [HR: 0.36 (0.19-0.65), p = 0.0008]. There was no significant interaction of AVR and rhythm (p = 0.57). Conclusions 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.
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Affiliation(s)
- Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Geoffrey D. Huntley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Edward A. El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christopher G. Scott
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sorin V. Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Katarina L. Fabre
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kevin L. Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jae K. Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Guo R, Fan C, Sun Z, Zhang H, Sun Y, Song L, Jiang Z, Liu L. Clinical efficacy and safety of Cox-maze IV procedure for atrial fibrillation in patients with aortic valve calcification. Front Cardiovasc Med 2023; 10:1092068. [PMID: 37077739 PMCID: PMC10106572 DOI: 10.3389/fcvm.2023.1092068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
ObjectiveAtrial fibrillation is associated with a high incidence of heart valve disease. There are few prospective clinical research comparing aortic valve replacement with and without surgical ablation for safety and effectiveness. The purpose of this study was to compare the results of aortic valve replacement with and without the Cox-maze IV procedure in patients with calcific aortic valvular disease and atrial fibrillation.MethodsWe analyzed one hundred and eight patients with calcific aortic valve disease and atrial fibrillation who underwent aortic valve replacement. Patients were divided into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox-maze operation (no Cox-maze group). After surgery, freedom from atrial fibrillation recurrence and all-cause mortality were evaluated.ResultsFreedom from all-cause mortality after aortic valve replacement at 1 year was 100% in the Cox-maze group and 89%, respectively, in the no Cox-maze group. No Cox-maze group had a lower rate of freedom from atrial fibrillation recurrence and arrhythmia control than those in the Cox-maze group (P = 0.003 and P = 0.012, respectively). Pre-operatively higher systolic blood pressure (hazard ratio, 1.096; 95% CI, 1.004–1.196; P = 0.04) and post-operatively increased right atrium diameters (hazard ratio, 1.755; 95% CI, 1.182–2.604; P = 0.005) were associated with atrial fibrillation recurrence.ConclusionThe Cox-maze IV surgery combined with aortic valve replacement increased mid-term survival and decreased mid-term atrial fibrillation recurrence in patients with calcific aortic valve disease and atrial fibrillation. Pre-operatively higher systolic blood pressure and post-operatively increased right atrium diameters are associated with the prediction of recurrence of atrial fibrillation.
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Ibrahim H, Thaden JJ, Fabre KL, Scott CG, Greason KL, Pislaru SV, Nkomo VT. Impact of Atrial Fibrillation on Outcomes in Very Severe Aortic Valve Stenosis. Am J Cardiol 2023; 189:64-69. [PMID: 36508765 DOI: 10.1016/j.amjcard.2022.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
The prevalence and impact of atrial fibrillation (AF) versus sinus rhythm (SR) on outcomes in very severe aortic stenosis (vsAS) of the native valve is unknown. The aim of the study was to determine the prognostic significance of AF in vsAS. A total of 563 patients with vsAS (transaortic valve peak velocity ≥5 m/s) and left ventricular ejection fraction ≥50% were identified retrospectively. Patients were divided by rhythm at the time of index transthoracic echocardiogram (AF: n = 50 [9%] vs SR: n = 513 [91%]). Patients with AF were older (83.1 ± 7.5 vs 72.5 ± 12.2 y, p <0.001) and had no difference in gender distribution (p = 0.49) but had a higher Charlson co-morbidity index (2 [1,3] vs 1 [0,2], p = 0.01). There was no difference in transaortic peak velocity (5.3 ± 0.3 m/s vs 5.4 ± 0.4 m/s, p = 0.13) and left ventricular ejection fraction was comparable (63 ± 7 vs 66 ± 7%, p = 0.01). Age-, gender-, Charlson co-morbidity index-, and time-dependent aortic valve replacement (AVR)-adjusted overall mortality at 5 years was significantly higher in patients with AF than patients with SR (hazard ratio [HR] 1.88 [1.23 to 2.85], p = 0.003). AVR was associated with improved survival (HR = 0.30 [0.22 to 0.42], p <0.001), with no statistically significant interaction of AVR and rhythm (p = 0.36). Outcomes were also compared in the 2 SR:1 AF propensity-matched analyses (100 SR: 50 AF), with matching done according to age, gender, clinical co-morbidities, and year of echocardiogram. In the propensity-matched analysis, age-, gender-, and time-dependent AVR-adjusted all-cause mortality was higher in AF (HR 2.32 [1.41 to 3.82], p <0.001). In conclusion, AF was not uncommon in vsAS and identified a subset of patients at a much higher risk of mortality without AVR.
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Affiliation(s)
- Hossam Ibrahim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katarina L Fabre
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Kubala M, Bohbot Y, Rusinaru D, Levy F, Maréchaux S, Tribouilloy C. Refining Risk Stratification in Severe Aortic Stenosis With Left Atrial Volume and Atrial Fibrillation. JACC Cardiovasc Imaging 2022; 15:945-947. [PMID: 35257679 DOI: 10.1016/j.jcmg.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
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Kubala M, de Chillou C, Bohbot Y, Lancellotti P, Enriquez-Sarano M, Tribouilloy C. Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward. Front Cardiovasc Med 2022; 9:792559. [PMID: 35242822 PMCID: PMC8885812 DOI: 10.3389/fcvm.2022.792559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.
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Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy, Vandœuvre lès Nancy, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, CHU Sart Tilman, Liège, Belgium
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
- *Correspondence: Christophe Tribouilloy
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10
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Impact of Atrial Fibrillation on Outcomes of Aortic Valve Implantation. Am J Cardiol 2022; 163:50-57. [PMID: 34772477 DOI: 10.1016/j.amjcard.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022]
Abstract
New or preexisting atrial fibrillation (AF) is frequent in patients undergoing aortic valve replacement. We evaluated whether the presence of AF during transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) impacts the length of stay, healthcare adjusted costs, and inpatient mortality. The median length of stay in the patients with AF increased by 33.3% as compared with those without AF undergoing TAVI and SAVR (5 [3 to 8] days vs 3 [2 to 6] days, p <0.0001 and 8 [6 to 12] days vs 6 [5 to 10] days, p <0.0001, respectively). AF increased the median value of adjusted healthcare associated costs of both TAVI ($46,754 [36,613 to 59,442] vs $49,960 [38,932 to 64,201], p <0.0001) and SAVR ($40,948 [31,762 to 55,854] vs $45,683 [35,154 to 63,026], p <0.0001). The presence of AF did not independently increase the in-hospital mortality. In conclusion, in patients undergoing SAVR or TAVI, AF significantly increased the length of stay and adjusted healthcare adjusted costs but did not independently increase the in-hospital mortality.
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11
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Ong CS, Reinertsen E, Moonsamy P, Young K, Song S, Axtell AL, Wolfe SB, Mohan N, Jassar AS, Aguirre AD, Sundt TM. Late onset atrial fibrillation in patients undergoing surgical aortic valve replacement. J Card Surg 2021; 37:285-289. [PMID: 34699088 DOI: 10.1111/jocs.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Aortic valve disease is a risk factor for atrial fibrillation (AF), and AF is associated with increased late mortality and morbidity after cardiac surgery. The evolution of alternative approaches to AF prophylaxis, including less invasive technologies and medical therapies, has altered the balance between risk and potential benefit for prophylactic intervention at the time of surgical aortic valve replacement (SAVR). Such interventions impose incremental risk, however, making an understanding of predictors of new onset AF that persists beyond the perioperative episode relevant. METHODS We conducted a retrospective single-institution cohort analysis of patients undergoing SAVR with no history of preoperative AF (n = 1014). These patients were cross-referenced against an institutional electrocardiogram (ECG) database to identify those with ECGs 3-12 months after surgery. Logistic regression was used to identify predictors of late AF. RESULTS Among the 401 patients (40%), who had ECGs in our institution 3-12 months after surgery, 16 (4%) had late AF. Patients with late AF were older than patients without late AF (73 vs. 65, p = .025), and underwent procedures that were more urgent/emergent (38% vs. 15%, p = .015), with higher predicted risk of mortality (2.2% vs. 1.3%, p = .012). Predictors associated with the development of late AF were advanced age, higher preoperative creatinine level and urgent/emergent surgery. CONCLUSIONS The incidence of late AF 3-12 months after SAVR, is low. Prophylactic AF interventions at the time of SAVR may not be warranted.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Erik Reinertsen
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Research Laboratory for Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Philicia Moonsamy
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Katherine Young
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Steven Song
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Axtell
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Navyatha Mohan
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Aaron D Aguirre
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
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12
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Differences in Clinical and Echocardiographic Profiles and Outcomes of Patients With Atrial Fibrillation Versus Sinus Rhythm in Medically Managed Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Heart Lung Circ 2020; 29:1773-1781. [DOI: 10.1016/j.hlc.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/01/2019] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
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13
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Murphy KR, Khan OA, Rassa AC, Elman MR, Chadderdon SM, Song HK, Golwala H, Cigarroa JE, Zahr FE. Clinical and Echocardiographic Predictors of Outcomes in Patients With Moderate (Mean Transvalvular Gradient 20 to 40 mm Hg) Aortic Stenosis. Am J Cardiol 2019; 124:1924-1931. [PMID: 31679642 DOI: 10.1016/j.amjcard.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023]
Abstract
Risk factors for adverse clinical outcomes in patients with moderate aortic stenosis are not well defined. Previous studies have suggested that certain patients with moderate AS may be at an increased risk of heart failure (HF) or death. All patients with moderate AS seen in our institution during the study period (6/1/2014 to 6/30/2017) with a minimum 1-year follow-up were included. Clinical and echocardiographic data were collected retrospectively. End points were defined as HF hospitalization, aortic valve replacement (AVR), or death. Kaplan-Meier and multivariable Cox proportional hazard models analyses were conducted using composite outcomes of (1) HF hospitalization or AVR and (2) HF hospitalization, AVR, or all-cause death. A total of 151 subjects met the inclusion criteria. The most significant risk factors associated with the composite outcomes were an ejection fraction (EF) <50% ((1) hazard ratio [HR]: 4.1; 95% confidence interval [CI]: 2.34, 7.12; (2) HR: 3.8; 95% CI: 2.2, 6.6), atrial fibrillation ((1) HR: 2.0; 95% CI: 1.2, 3.2; (2) HR: 2.1; 95% CI: 1.43, 3.2), left ventricular hypertrophy ((1) HR: 5.85; 95% CI: 2.0, 15.8; (2) HR: 3.2; 95% CI: 1.4, 7.4), aortic valve area ((1) HR: 0.3; 95% CI: 0.1, 0.6; (2) HR: 0.32; 95% CI: 0.1, 0.65), and abnormal right ventricular function ((1) HR: 4.3; 95% CI: 2.5, 7.5; (2) HR: 5.5; 95% CI: 3.0, 9.8). In conclusion, presence of reduced ejection fraction, atrial fibrillation, left ventricular hypertrophy, and abnormal right ventricular function are associated with an increased risk of HF hospitalization, AVR, and death in patients with moderate aortic stenosis.
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Affiliation(s)
- Katie R Murphy
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Omar A Khan
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Allen C Rassa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Miriam R Elman
- School of Public Health, Portland State University-Oregon Health & Science University, Portland, Oregon
| | - Scott M Chadderdon
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Howard K Song
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Division of Cardiothoracic Surgery, Oregon Health & Science University, Portland, Oregon
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Firas E Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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14
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Maréchaux S, Rusinaru D, Altes A, Pasquet A, Vanoverschelde JL, Tribouilloy C. Prognostic Value of Low Flow in Patients With High Transvalvular Gradient Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction: A Multicenter Study. Circ Cardiovasc Imaging 2019; 12:e009299. [PMID: 31597467 DOI: 10.1161/circimaging.119.009299] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Grading of severe (aortic valve area ≤1 cm2) aortic stenosis with preserved left ventricular ejection fraction is based on a classification depending on flow (normal flow versus low flow) and pressure gradient (low gradient versus high gradient). The aim of the present study was to compare the outcome of patients with normal flow high gradient and low flow high gradient severe aortic stenosis (SAS) with no or minimal symptoms. METHODS This multicenter study enrolled 983 consecutive patients (mean age 75±11 years, 459 women) with asymptomatic or minimally symptomatic HG (mean pressure gradient ≥40 mm Hg) SAS with preserved left ventricular ejection fraction. Low flow was defined by Doppler echocardiography as a stroke volume index <30 mL/m2 (n=131) or a stroke volume <55 mL (n=136). The end point was all-cause mortality. RESULTS During a median follow-up period of 48 (45-52) months, 225 patients (23%) died. The 60-month mortality was higher in low flow high gradient SAS compared with normal flow high gradient SAS (36±5% versus 22±2% and 38±5% versus 21±2% for stroke volume index and stroke volume, respectively, both P<0.0001). After adjustment for outcome predictors including aortic valve replacement as time-dependent covariate, low flow high gradient SAS displayed considerable mortality risk during follow up compared with normal flow high gradient SAS (adjusted HR 2.17 [1.51-3.13]; P<0.0001 for stroke volume index <30 mL/m2 and adjusted HR 1.86 [1.29-2.68]; P=0.001, for stroke volume <55 mL). The prognostic impact of low flow was consistent in subgroups of patients. CONCLUSIONS Asymptomatic or minimally symptomatic patients with low flow high gradient SAS and preserved left ventricular ejection fraction have a considerable increased risk of mortality during follow-up. These patients should be promptly considered for aortic valve replacement.
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Affiliation(s)
- Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Cardiology department and Heart Valve Center, Faculté libre de médecine/Université Catholique de Lille, France (S.M., A.A.).,Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.)
| | - Dan Rusinaru
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.).,Department of Cardiology, Amiens University Hospital, France (D.R., C.T.)
| | - Alexandre Altes
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Cardiology department and Heart Valve Center, Faculté libre de médecine/Université Catholique de Lille, France (S.M., A.A.)
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.L.V.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.L.V.)
| | - Jean Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.L.V.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.L.V.)
| | - Christophe Tribouilloy
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.).,Department of Cardiology, Amiens University Hospital, France (D.R., C.T.)
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15
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Zhang H, El-Am EA, Thaden JJ, Pislaru SV, Scott CG, Krittanawong C, Chahal AA, Breen TJ, Eleid MF, Melduni RM, Greason KL, McCully RB, Enriquez-Sarano M, Oh JK, Pellikka PA, Nkomo VT. Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis. Heart 2019; 106:280-286. [PMID: 31439661 DOI: 10.1136/heartjnl-2019-314996] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To examine the prognostic significance of atrial fibrillation (AF) versus sinus rhythm (SR) on the management and outcomes of patients with severe aortic stenosis (AS). METHODS 1847 consecutive patients with severe AS (aortic valve area ≤1.0 cm2 and aortic valve systolic mean Doppler gradient ≥40 mm Hg or peak velocity ≥4 m/s) and left ventricular ejection fraction ≥50% were identified. The independent association of AF and all-cause mortality was assessed. RESULTS Age was 76±11 years and 46% were female; 293 (16%) patients had AF and 1554 (84%) had SR. In AF, 72% were symptomatic versus 71% in SR. Survival rate at 5 years for AF (41%) was lower than SR (65%) (age- and sex-adjusted HR=1.66 (1.40-1.98), p<0.0001). In multivariable analysis, factors associated with mortality included age (HR per 10 years=1.55 (1.42-1.69), p<0.0001), dyspnoea (HR=1.58 (1.33-1.87), p<0.0001), ≥ moderate mitral regurgitation (HR=1.63 (1.22-2.18), p=0.001), right ventricular systolic dysfunction (HR=1.88 (1.52-2.33), p<0.0001), left atrial volume index (HR per 10 mL/m2=1.13 (1.07-1.19), p<0.0001) and aortic valve replacement (AVR) (HR=0.44 (0.38-0.52), p<0.0001). AF was not a predictor of mortality independent of variables strongly correlated HR=1.02 (0.84-1.25), p=0.81). The 1-year probability of AVR following diagnosis of severe AS was lower in AF (49.8%) than SR (62.5%) (HR=0.73 (0.62-0.86), p<0.001); among patients with AF not referred for AVR, symptoms were frequently attributed to AF instead of AS. CONCLUSION AF was associated with poor prognosis in patients with severe AS, but apparent differences in outcomes compared with SR were explained by factors other than AF including concomitant cardiac abnormalities and deferral of AVR due to attribution of cardiac symptoms to AF.
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Affiliation(s)
- Hongju Zhang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Edward A El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Christopher G Scott
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Thomas J Breen
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Rowlens M Melduni
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Robert B McCully
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
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16
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Ramos M, Quezada DM, Ayala R, Gómez-Pavón FJ, Jaramillo J, Toro R. Aortic stenosis prognosis in older patients: frailty is a strong marker of early congestive heart failure admissions. Eur Geriatr Med 2019; 10:483-491. [DOI: 10.1007/s41999-019-00165-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/09/2019] [Indexed: 01/09/2023]
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17
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Li B, Luo F, Luo X, Li B, Qi L, Zhang D, Tang Y. Effects of atrial fibrosis induced by mitral regurgitation on atrial electrophysiology and susceptibility to atrial fibrillation in pigs. Cardiovasc Pathol 2019; 40:32-40. [DOI: 10.1016/j.carpath.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/28/2023] Open
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18
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Suwalski P, Kowalewski M, Jasiński M, Staromłyński J, Zembala M, Widenka K, Brykczyński M, Skiba J, Zembala MO, Bartuś K, Hirnle T, Dziembowska I, Tobota Z, Maruszewski BJ, Anisimowicz L, Biederman A, Borkowski D, Bugajski P, Cholewiński P, Cichoń R, Cisowski M, Deja M, Dziatkowiak A, Gburek T, Gryczko L, Haponiuk I, Hendzel P, Jabłonka S, Jarmoszewicz K, Jasiński J, Jaszewski R, Jemielity M, Kalawski R, Kapelak B, Kaperczak J, Karolczak MA, Krejca M, Kustrzycki W, Kuśmierczyk M, Kwinecki P, Missima M, Moll JJ, Ogorzeja W, Pająk J, Pawliszak W, Pietrzyk E, Religa G, Rogowski J, Różański J, Sadowski J, Sharma G, Skalski J, Stanisławski R, Stążka J, Stępiński P, Suwalski K, Tułecki Ł, Wojtalik M, Woś S, Żelazny P. Survival after surgical ablation for atrial fibrillation in mitral valve surgery: Analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK). J Thorac Cardiovasc Surg 2019; 157:1007-1018.e4. [DOI: 10.1016/j.jtcvs.2018.07.099] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 01/10/2023]
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19
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Mene-Afejuku TO, López PD, Akinlonu A, Dumancas C, Visco F, Mushiyev S, Pekler G. Atrial Fibrillation in Patients with Heart Failure: Current State and Future Directions. Am J Cardiovasc Drugs 2018; 18:347-360. [PMID: 29623658 DOI: 10.1007/s40256-018-0276-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure affects nearly 26 million people worldwide. Patients with heart failure are frequently affected with atrial fibrillation, and the interrelation between these pathologies is complex. Atrial fibrillation shares the same risk factors as heart failure. Moreover, it is associated with a higher-risk baseline clinical status and higher mortality rates in patients with heart failure. The mechanisms by which atrial fibrillation occurs in a failing heart are incompletely understood, but animal studies suggest they differ from those that occur in a healthy heart. Data suggest that heart failure-induced atrial fibrosis and atrial ionic remodeling are the underlying abnormalities that facilitate atrial fibrillation. Therapeutic considerations for atrial fibrillation in patients with heart failure include risk factor modification and guideline-directed medical therapy, anticoagulation, rate control, and rhythm control. As recommended for atrial fibrillation in the non-failing heart, anticoagulation in patients with heart failure should be guided by a careful estimation of the risk of embolic events versus the risk of hemorrhagic episodes. The decision whether to target a rate-control or rhythm-control strategy is an evolving aspect of management. Currently, both approaches are good medical practice, but recent data suggest that rhythm control, particularly when achieved through catheter ablation, is associated with improved outcomes. A promising field of research is the application of neurohormonal modulation to prevent the creation of the "structural substrate" for atrial fibrillation in the failing heart.
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20
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Predicting Outcomes in Patients With AsymptomaticModerate to Severe Aortic Stenosis. Am J Cardiol 2018; 122:851-858. [PMID: 30037422 DOI: 10.1016/j.amjcard.2018.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/21/2022]
Abstract
Outcomes in asymptomatic patients with aortic stenosis (AS) have been reported primarily from tertiary centers. Whether observations from a community hospital cohort would be similar or if clinical variables would assume a more important role remains uncertain. This retrospective cohort study from one community hospital followed asymptomatic patients with moderate to severe AS for 3 years following an index echocardiogram. Patients underwent standard echocardiographic imaging and assessment of AS severity. Outcomes included aortic valve replacement, onset of Class 4 heart failure and cardiovascular death. Inclusion or exclusion criteria were met by 190 patients (body mass index of 30.8 ± 7.5 kg/m2 and age 70.9 ± 13.0 years). In this obese and racially diverse cohort, adverse outcomes occurred in 72 of 190 (38%), aortic valve replacement in 33 of 72 (46%), heart failure in 30 of 72 (42%), and cardiovascular death in 9 of 72 (13%). Univariate analyses found that the echocardiographic variables assessing AS severity (Vmax, mean aortic valve gradient, and the dimensionless index) were strongly associated with outcomes. A model predicting time to adverse outcomes included age, gender, Charlson index, Vmax, aortic valve area, the electrocardiographic variables of atrial fibrillation and left ventricular strain, and echocardiographic variables unrelated to the direct measurements of stenosis severity. In conclusion, direct echocardiographic measures of AS severity, echocardiographic parameters unrelated to AS severity plus the electrocardiographic variables of atrial fibrillation and left ventricular strain were the dominant predictors of adverse outcomes in a community hospital cohort of asymptomatic patients with moderate to severe AS.
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21
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Abubakar H, Yassin AS, Akintoye E, Bakhit K, Pahuja M, Shokr M, Lieberman R, Afonso L. Financial Implications and Impact of Pre-existing Atrial Fibrillation on In-Hospital Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the National Inpatient Database). Am J Cardiol 2018; 121:1587-1592. [PMID: 29622287 DOI: 10.1016/j.amjcard.2018.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/09/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
The objective of this study was to evaluate the financial implications and the impact of pre-existing atrial fibrillation (AF) on in-hospital outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) using the Nationwide Inpatient Sample (NIS) database. We identified patients who underwent TAVI from 2011 to 2014. The primary end point was the effect of pre-existing AF on in-hospital mortality. Secondary end points included periprocedural cardiac complications, stroke, and hemorrhage requiring transfusion. We also assessed length of stay (LOS) and cost of hospitalization. A mixed-effect logistic model was used for clinical end points, and a linear mixed model was used for cost and LOS. In 6,778 patients who underwent TAVI (46.1% women and 81.4 ± 8.5 years old), the incidence of AF was 43.3%. After adjusting for patient- and hospital-level characteristics, pre-existing AF was not found to influence in-hospital mortality (odds ratio 1.05, 95% confidence interval 0.80 to 1.36). AF was associated with an increased risk of periprocedural cardiac complications (odds ratio 1.46, 95% confidence interval 1.22 to 1.75), longer LOS (p <0.001) and an increased cost of hospitalization (US$51,852 vs US$49,599). In conclusion, pre-existing AF did not impact in-hospital mortality in TAVI patients but was associated with increased cardiac complications, a longer hospital LOS, and a higher cost of hospitalization.
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22
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Rankin JS, Grau-Sepulveda MV, Ad N, Damiano RJ, Gillinov AM, Brennan JM, McCarthy PM, Thourani VH, Jacobs JP, Shahian DM, Badhwar V. Associations Between Surgical Ablation and Operative Mortality After Mitral Valve Procedures. Ann Thorac Surg 2018; 105:1790-1796. [DOI: 10.1016/j.athoracsur.2017.12.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/25/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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23
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Clinical Significance of Ejection Dynamics Parameters in Patients with Aortic Stenosis: An Outcome Study. J Am Soc Echocardiogr 2018; 31:551-560.e2. [DOI: 10.1016/j.echo.2017.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Indexed: 01/02/2023]
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24
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Rusinaru D, Bohbot Y, Kowalski C, Ringle A, Maréchaux S, Tribouilloy C. Left Atrial Volume and Mortality in Patients With Aortic Stenosis. J Am Heart Assoc 2017; 6:JAHA.117.006615. [PMID: 29089338 PMCID: PMC5721760 DOI: 10.1161/jaha.117.006615] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Left atrium (LA) enlargement is common in patients with aortic stenosis (AS), yet its prognostic implications are unclear. This study investigates the value of left atrial volume (LAV) and LAV normalized to body size for predicting mortality in AS. Methods and Results We included 1351 patients with AS in sinus rhythm at diagnosis and analyzed the occurrence of all‐cause death during follow‐up with medical and surgical management. Five parameters of LA enlargement were tested: nonindexed LAV and normalized LAV by ratiometric (LAV/body surface area [BSA] and LAV/height) and allometric (LAV/BSA1.7 and LAV/height2.0) scaling. For each parameter, patients in the highest quartile were at high risk of death, whereas outcome was better and similar for the other quartiles. Five‐year survival was lower for patients with LAV >95 mL and LAV/BSA >50 mL/m2 compared with those with no or mild LA enlargement (both P<0.001). After adjustment for established outcome predictors, including surgery, high risk of death was observed with LAV >95 mL (adjusted hazard ratio, 1.40 [95% confidence interval, 1.06–1.88]) and LAV/BSA >50 mL/m2 (adjusted hazard ratio, 1.42 [95% confidence interval, 1.08–1.91]). LAV/BSA and LAV showed good and similar predictive performance, whereas other scaling methods did not show better outcome prediction. In patients with severe AS at baseline, preserved (≥50%) ejection fraction, and no or minimal symptoms, LA enlargement was significantly associated with mortality (adjusted hazard ratio, 1.87 [95% confidence interval, 1.02–3.44] for LAV >95 mL, and adjusted hazard ratio, 1.90 [95% confidence interval, 1.03–3.56] for LAV/BSA >50 mL/m2). Conclusions LA enlargement is an important predictor of mortality in AS, incrementally to known predictors of outcome. LAV and LAV/BSA have comparable predictive performance and should be assessed in clinical practice for risk stratification.
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Affiliation(s)
- Dan Rusinaru
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,INSERM U-1088, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France
| | - Cédric Kowalski
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine, Université Lille Nord de France, Lille, France
| | - Sylvestre Maréchaux
- INSERM U-1088, Jules Verne University of Picardie, Amiens, France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine, Université Lille Nord de France, Lille, France
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France .,INSERM U-1088, Jules Verne University of Picardie, Amiens, France
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25
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Determinants of left atrial volume index in patients with aortic stenosis: A multicentre pilot study. Arch Cardiovasc Dis 2017; 110:525-533. [DOI: 10.1016/j.acvd.2016.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
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Salaun E, Casalta AC, Donal E, Bohbot Y, Galli E, Tribouilloy C, Hubert S, Magne J, Mancini J, Renard S, Avierinos JF, Maysou LA, Lavoute C, Szymanski C, Haentjens J, Habib G. Apical four-chamber longitudinal left ventricular strain in patients with aortic stenosis and preserved left ventricular ejection fraction: analysis related with flow/gradient pattern and association with outcome. Eur Heart J Cardiovasc Imaging 2017; 19:868-878. [DOI: 10.1093/ehjci/jex203] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erwan Salaun
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Anne-Claire Casalta
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Erwan Donal
- Cardiology department & CIC-IT 1414, hôpital Pontchaillou, university hospital of Rennes, 35033 Rennes, France
| | - Yohann Bohbot
- Cardiology department, university hospital of Amiens, avenue René-Laënnec, 80054 Amiens cedex 1, France
| | - Elena Galli
- Cardiology department & CIC-IT 1414, hôpital Pontchaillou, university hospital of Rennes, 35033 Rennes, France
| | - Christophe Tribouilloy
- Cardiology department, university hospital of Amiens, avenue René-Laënnec, 80054 Amiens cedex 1, France
| | - Sandrine Hubert
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Julien Mancini
- Aix-Marseille Université, Inserm, IRD, UMR912, SESSTIM, Marseille F-13273, France
- Public Health Department (BIOSTIC), APHM, Timone Hospital, Marseille F-13385, France
| | - Sebastien Renard
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | | | - Laurie-Anne Maysou
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Cécile Lavoute
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Catherine Szymanski
- Cardiology department, university hospital of Amiens, avenue René-Laënnec, 80054 Amiens cedex 1, France
| | - Julie Haentjens
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
| | - Gilbert Habib
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France
- Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France
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Antunes MJ. Is new-onset postoperative atrial fibrillation a benign complication? J Thorac Cardiovasc Surg 2017; 154:490-491. [DOI: 10.1016/j.jtcvs.2017.03.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
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Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, McCarthy PM, Thourani VH, Suri RM, Jacobs JP, Cox JL. Surgical Ablation of Atrial Fibrillation in the United States: Trends and Propensity Matched Outcomes. Ann Thorac Surg 2017; 104:493-500. [DOI: 10.1016/j.athoracsur.2017.05.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2017; 103:329-341. [PMID: 28007240 DOI: 10.1016/j.athoracsur.2016.10.076] [Citation(s) in RCA: 317] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
Abstract
EXECUTIVE SUMMARY Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion).
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Yamauchi T, Sakata Y, Miura M, Onose T, Tsuji K, Abe R, Oikawa T, Kasahara S, Sato M, Nochioka K, Shiroto T, Takahashi J, Miyata S, Shimokawa H. Prognostic Impact of Atrial Fibrillation and New Risk Score of Its Onset in Patients at High Risk of Heart Failure - A Report From the CHART-2 Study. Circ J 2017; 81:185-194. [PMID: 28090009 DOI: 10.1253/circj.cj-16-0759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic impact of atrial fibrillation (AF) among patients at high risk for heart failure (HF) remains unclear. In addition, there is no risk estimation model for AF development in these patients.Methods and Results:The present study included 5,382 consecutive patients at high risk of HF enrolled in the CHART-2 Study (n=10,219). At enrollment, 1,217 (22.6%) had AF, and were characterized, as compared with non-AF patients, by higher age, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP) level and lower left ventricular ejection fraction. A total of 116 non-AF patients (2.8%) newly developed AF (new AF) during the median 3.1-year follow-up. AF at enrollment was associated with worse prognosis for both all-cause death and HF hospitalization (adjusted hazard ratio (aHR) 1.31, P=0.027 and aHR 1.74, P=0.001, for all-cause death and HF hospitalization, respectively) and new AF was associated with HF hospitalization (aHR 4.54, P<0.001). We developed a risk score with higher age, smoking, pulse pressure, lower eGFR, higher BNP, aortic valvular regurgitation, LV hypertrophy, and left atrial and ventricular dilatation on echocardiography, which effectively stratified the risk of AF development with excellent accuracy (AUC 0.76). CONCLUSIONS These results indicated that AF is associated with worse prognosis in patients at high risk of HF, and our new risk score may be useful to identify patients at high risk for AF onset.
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Affiliation(s)
- Takeshi Yamauchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Levy F, Tribouilloy C. Letter by Levy and Tribouilloy Regarding Article, "Atrial Fibrillation Is Associated With Increased Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valve (PARTNER) Trial". Circ Cardiovasc Interv 2016; 9:e003705. [PMID: 27162218 DOI: 10.1161/circinterventions.116.003705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Amiens, France, INSERM U-1088, Jules Verne University of Picardie, Amiens, France
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Scarsoglio S, Saglietto A, Gaita F, Ridolfi L, Anselmino M. Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation. PeerJ 2016; 4:e2240. [PMID: 27547548 PMCID: PMC4974931 DOI: 10.7717/peerj.2240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/21/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. METHODS We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i) irregular, uncorrelated and faster heart rate; (ii) atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation), by varying-through the valve opening angle-the valve area. RESULTS Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. DISCUSSION The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive treatment of AF. Present findings, if clinically confirmed, hold the potential to impact AF management (e.g., adoption of a rhythm control strategy) in specific valvular diseases.
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Affiliation(s)
- Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Torino, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Torino, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, University of Turin, Torino, Italy
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Furukawa A, Abe Y, Ito M, Tanaka C, Ito K, Komatsu R, Haze K, Naruko T, Yoshiyama M, Yoshikawa J. Prediction of aortic stenosis-related events in patients with systolic ejection murmur using pocket-sized echocardiography. J Cardiol 2016; 69:189-194. [PMID: 27012751 DOI: 10.1016/j.jjcc.2016.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND We have previously reported the usefulness of our newly developed visual aortic stenosis (AS) score in screening for AS using pocket-sized echocardiography. The objective of this study was to investigate whether the visual AS score and/or conventional aortic valve calcification score derived from pocket-sized echocardiography can be used to predict AS-related events. METHODS One hundred and nine patients with systolic ejection murmur (SEM) or known AS (64 males, age 75±9 years) were enrolled and a visual AS score and an aortic valve calcification score were assessed using pocket-sized echocardiography. The primary endpoint was defined as AS-related events, including cardiac death and aortic valve replacement, during the follow-up period. RESULTS In a multivariate Cox proportional hazards analysis, AS-related events were independently predicted by an aortic valve calcification score ≥3 (HR, 3.5; 95% CI, 1.1-11; p=0.033) and a visual AS score ≥3 (HR, 15; 95% CI, 1.8-125; p=0.013). During 18±9 months of follow-up, the event-free survival rate was 98% in patients with both a visual AS score <3 and an aortic valve calcification score <3, 90% in patients with either a visual AS score ≥3 or an aortic valve calcification score ≥3 (p<0.0001), and 62% in patients with both a visual AS score ≥3 and an aortic valve calcification score ≥3 (p<0.0001). CONCLUSIONS The combination of visual AS score and aortic valve calcification score derived from pocket-sized echocardiography is useful for predicting AS-related events in patients with SEM.
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Affiliation(s)
- Atsuko Furukawa
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Makoto Ito
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Chiharu Tanaka
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kazato Ito
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Ryushi Komatsu
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kazuo Haze
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Medical School, Osaka, Japan
| | - Junichi Yoshikawa
- Department of Cardiology, Nishinomiya-Watanabe Cardiovascular Center, Nishinomiya, Japan
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