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Hemodynamic profile of patients with severe aortic valve stenosis and atrial fibrillation versus sinus rhythm

Lukas Weber, Hans Rickli, Peter Ammann, Maurizio Taramasso, Roman Brenner, Niklas Ehl, Marc Buser, Philipp K. Haager, Francesco Maisano & Micha T. Maeder

abstract

BACKGROUND
In patients with severe aortic stenosis (AS), atrial fibrillation (AF) is associated with increased long-term mortality after aortic valve replacement (AVR), which may be due to unfavorable hemodynamics in AF. We aimed to analyze the hemodynamic profile of patients with severe AS and AF versus sinus rhythm (SR).

METHODS
We performed cardiac catheterization in 486 patients (age 74 ± 10 years, 58% males) with severe AS [indexed aortic valve area 0.41 ± 0.13 cm, left ventricular ejection fraction 58 ± 12%]: 50 patients had AF, and 436 patients had SR. All patients underwent surgical (n = 350) or transcatheter (n = 136) AVR.

RESULTS
Despite similar indexed aortic valve area (0.41 ± 0.11 vs. 0.41 ± 0.12 cm/m; p = 0.45) patients with AF had lower left ventricular ejection fraction, larger left atrial size, lower tricuspid annular plane systolic excursion, higher mean pulmonary artery pressure (34 ± 13 vs. 24 ± 9 mmHg), mean pulmonary artery wedge pressure (mPAWP; 22 ± 8 vs. 15 ± 7 mmHg), and pulmonary vascular resistance (2.8 ± 1.9 vs. 2.0 ± 1.3 Wood units) and lower stroke volume index (26 ± 9 vs. 37 ± 10 ml/m) than patients with SR (p < 0.05 for all). Patients with AF and SR had a different mPAWP-left ventricular end-diastolic pressure (LVEDP) relationship with higher mPAWP in AF and higher LVEDP in SR. After a median follow-up of 49 (interquartile range, 35-64) months post-AVR patients with AF (p = 0.05) and patients with a larger difference between mPAWP and LVEDP (p = 0.005) had higher mortality.

CONCLUSIONS
Patients with severe AS and concomitant AF have a distinct and significantly worse hemodynamic profile compared to patients with SR associated with worse clinical outcome.
   
citation Weber L, Rickli H, Ammann P, Taramasso M, Brenner R, Ehl N, Buser M, Haager P K, Maisano F, Maeder M T. Hemodynamic profile of patients with severe aortic valve stenosis and atrial fibrillation versus sinus rhythm. Int J Cardiol 2020;.
   
type journal paper/review (English)
date of publishing 01-04-2020
journal title Int J Cardiol
ISSN electronic 1874-1754
PubMed 32276775
DOI 10.1016/j.ijcard.2020.03.084