Affiliation:
1. Department of Cardiovascular Diseases, Mayo Clinic Arizona , 13400 E Shea Blvd, Scottsdale, AZ 85259 , USA
2. Department of Cardiovascular Diseases, Mayo Clinic , 200 1st St SW, Rochester, MN 55905 , USA
Abstract
Abstract
Aims
Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared with patients with sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS).
Methods and results
Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. Baseline characteristics and overall survival were compared between those with SR and AF. There were 820 patients (mean age 81 years; 41.6% females) included in this study. AF was present in 356 patients. Patients with AF were older (82.2 vs. 80.5, P = 0.003) and had a lower MG compared with patients with SR (42.0 vs. 44.9, P = 0.002) with similar indexed aortic valve area (0.4 vs. 0.4, P = 0.17). Median AVCS was higher in AF (males: AF 2850.0 vs. SR 2561.0, P = 0.044; females: AF 1942.0 vs. SR 1610.5, P = 0.025). Projected AVCS, assuming the same age of diagnosis, was similar between AF and SR. Median survival post-TAVR was worse in AF compared with SR (3.2 vs. 5.4 years, log rank P < 0.001). AF, lower MG, higher right ventricular systolic pressure, dialysis, diabetes, and significant tricuspid regurgitation were associated with higher mortality (P < 0.05 for all).
Conclusion
Older age and higher AVCS in patients with AF compared with those with SR suggest that AS was both underestimated and more advanced at TAVR referral.
Publisher
Oxford University Press (OUP)
Reference28 articles.
1. Calcific aortic stenosis: a disease of the valve and the myocardium;Dweck;J Am Coll Cardiol,2012
2. Aortic stenosis in the elderly;Osnabrugge;J Am Coll Cardiol,2013
3. Atrial fibrillation and aortic stenosis;Stortecky;Circ Cardiovasc Interv,2013
4. Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome;Tarantini;Eur Heart J,2016
5. Aortic valve hemodynamics in atrial fibrillation: should the highest Doppler signal be used to estimate severity of aortic stenosis?;Alsidawi;Echocardiography,2018