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

Publication

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

Journal Paper/Review - Apr 1, 2020

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

Citation

Weber L, Maisano F, Haager P, Buser M, Ehl N, Brenner R, Taramasso M, Ammann P, Rickli H, Maeder M. Hemodynamic profile of patients with severe aortic valve stenosis and atrial fibrillation versus sinus rhythm. Int J Cardiol 2020

Type

Journal Paper/Review (English)

Journal

Int J Cardiol 2020

Publication Date

Apr 1, 2020

Issn Electronic

1874-1754

Brief description/objective

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.