Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Teppo, Konsta; Airaksinen, Juhani; Biancari, Fausto; Jaakkola, Jussi; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Mustonen, Pirjo; Kinnunen, Janne; Luojus, Alex; Hartikainen, Juha; A, Aro; Lehto, Mika

doi:10.1161/jaha.122.029337

Cited by 3 publications

(1 citation statement)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, AS should be considered in the bleeding risk assessment of patients with atrial fibrillation with an increased risk of gastrointestinal bleeding [69].…”

Section: Stress Echo In As and Prognosismentioning

confidence: 99%

ABCDEG Stress Echocardiography in Aortic Stenosis

Ciampi

Cortigiani²,

Ruiz

et al. 2023

Diagnostics

View full text Add to dashboard Cite

Rest and stress echocardiography (SE) plays a pivotal role in the evaluation of valvular heart disease. The use of SE is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms. In aortic stenosis (AS), rest echocardiographic analysis is a stepwise approach that begins with the evaluation of aortic valve morphology and proceeds to the measurement of the transvalvular aortic gradient and aortic valve area (AVA) using continuity equations or planimetry. The presence of the following three criteria suggests severe AS: AVA < 1.0 cm2, a peak velocity > 4.0 m/s, or a mean gradient > 40 mmHg. However, in approximately one in three cases, we can observe a discordant AVA < 1 cm2 with a peak velocity < 4.0 m/s or a mean gradient <40 mmHg. This is due to reduced transvalvular flow associated with LV systolic dysfunction (LVEF < 50%) defined as “classical” low-flow low-gradient (LFLG) AS or normal LVEF “paradoxical” LFLG AS. SE has an established role in evaluating LV contractile reserve (CR) patients with reduced LVEF. In classical LFLG AS, LV CR distinguished pseudo-severe AS from truly severe AS. Some observational data suggest that long-term prognosis in asymptomatic severe AS may not be as favorable as previously thought, offering a window of opportunity for intervention prior to the onset of symptoms. Therefore, guidelines recommend evaluating asymptomatic AS with exercise stress in physically active patients, particularly those younger than 70 years, and symptomatic classical LFLG severe AS with low-dose dobutamine SE. A comprehensive SE assessment includes evaluating valve function (gradients), the global systolic function of the LV, and pulmonary congestion. This assessment integrates considerations of blood pressure response, chronotropic reserve, and symptoms. StressEcho 2030 is a prospective, large-scale study that employs a comprehensive protocol (ABCDEG) to analyze the clinical and echocardiographic phenotypes of AS, capturing various vulnerability sources which support stress echo-driven treatment strategies.

show abstract

“…Finally, AS should be considered in the bleeding risk assessment of patients with atrial fibrillation with an increased risk of gastrointestinal bleeding [69].…”

Section: Stress Echo In As and Prognosismentioning

confidence: 99%

ABCDEG Stress Echocardiography in Aortic Stenosis

Ciampi

Cortigiani²,

Ruiz

et al. 2023

Diagnostics

View full text Add to dashboard Cite

show abstract

Prevalence and prognosis of aortic valve diseases in patients hospitalized with heart failure with mildly reduced ejection fraction

Schupp,

Abel,

Schmidberger

et al. 2024

European J of Heart Fail

View full text Add to dashboard Cite

AimsData regarding the characterization and outcomes of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is scarce. This study investigates the characteristics and prognostic impact of native aortic valve diseases (AVD) in patients with HFmrEF.Methods and resultsConsecutive patients hospitalized with HFmrEF (i.e. left ventricular ejection fraction 41–49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognostic impact of native aortic valve stenosis (AS), aortic valve regurgitation (AR) and mixed AVD (MAVD) was investigated for the primary endpoint of long‐term all‐cause mortality during a median follow‐up of 30 months. Kaplan–Meier, univariable and multivariable Cox proportional analyses were applied. From a total of 2106 patients hospitalized with HFmrEF, the prevalence of AS and AR was 16.5% and 31.2%, respectively (MAVD 7.8%). The presence of moderate/severe AS was associated with a higher risk of long‐term all‐cause mortality (44.8% vs. 28.7%; p = 0.001) and HF‐related rehospitalization (18.6% vs. 12.0%; p = 0.001), even after multivariable adjustment (mortality: hazard ratio [HR] 1.320; 95% confidence interval [CI] 1.035–1.684; p = 0.025; HF‐related rehospitalization: HR 1.570; 95% CI 1.101–2.241; p = 0.013). Interestingly, even mild AS was associated with increased risk of long‐term all‐cause mortality compared to patients without AS (HR 1.477; 95% CI 1.101–1.982; p = 0.009). In contrast, the presence of AR was not associated with long‐term outcomes after multivariable adjustment.ConclusionsThe presence of AS, but not AR, was independently associated with increased risk of all‐cause mortality and HF‐related rehospitalization in patients with HFmrEF. Even milder stages of AS were associated with impaired prognosis.

show abstract

Optimizing Anticoagulation in Valvular Heart Disease: Navigating NOACs and VKAs

Ouatu,

Buliga-Finiș,

Tanase

et al. 2024

JPM

View full text Add to dashboard Cite

Background/Objectives: Non-vitamin K antagonist oral anticoagulants (NOACs) have demonstrated similar effectiveness and safety profiles to vitamin K antagonists (VKAs) in treating nonvalvular atrial fibrillation (AF). Given their favorable pharmacological profile, including the rapid onset and offset of action, fixed dosing, and predictable pharmacokinetics with a consistent dose-response relationship, reducing the need for frequent blood tests, researchers have investigated the potential of NOACs in patients with AF and valvular heart disease (VHD). Methods: Clinical trials, excluding patients with mechanical prosthetic valves or moderate/severe mitral stenosis, have shown the benefits of NOACs over VKAs in this population. However, there is a need for further research to determine if these findings apply to mechanical valve prostheses and NOACs. Results: Several ongoing randomized controlled trials are underway to provide more definitive evidence regarding NOAC treatment in moderate to severe rheumatic mitral stenosis. Importantly, recent trials that included patients with atrial fibrillation and bioprosthetic valves (also transcatheter heart valves) have provided evidence supporting the safety of NOACs in this specific patient population. Ongoing research aims to clearly define the specific scenarios where NOACs can be safely and effectively prescribed for various types of VHD, including moderate/severe mitral stenosis and mechanical valves. Conclusions: The aim of this review is to accurately identify the specific situations in which NOACs can be prescribed in patients with VHD, with a focus centered on each type of valvulopathy.

show abstract

Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Cited by 3 publications

References 30 publications

ABCDEG Stress Echocardiography in Aortic Stenosis

ABCDEG Stress Echocardiography in Aortic Stenosis

Prevalence and prognosis of aortic valve diseases in patients hospitalized with heart failure with mildly reduced ejection fraction

Optimizing Anticoagulation in Valvular Heart Disease: Navigating NOACs and VKAs

Contact Info

Product

Resources

About