Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Abstract Background Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation...

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Veröffentlicht in:European heart journal 2021-10, Vol.42 (Supplement_1)
Hauptverfasser: Samaras, A, Vrana, E, Kartas, A, Rampidis, G, Doundoulakis, I, Fotos, G, Efthimiadis, G, Karvounis, H, Tzikas, A, Giannakoulas, G
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container_issue Supplement_1
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container_title European heart journal
container_volume 42
creator Samaras, A
Vrana, E
Kartas, A
Rampidis, G
Doundoulakis, I
Fotos, G
Efthimiadis, G
Karvounis, H
Tzikas, A
Giannakoulas, G
description Abstract Background Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence. Purpose To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged
doi_str_mv 10.1093/eurheartj/ehab724.0421
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Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence. Purpose To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged &lt;80 years and in those without history of heart failure (p for interaction &lt;0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p&lt;0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD. Conclusions Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis. Funding Acknowledgement Type of funding sources: None. Subgroup analyses by VHD statusPrognostic impact of valve lesions</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehab724.0421</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2021-10, Vol.42 (Supplement_1)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Samaras, A</creatorcontrib><creatorcontrib>Vrana, E</creatorcontrib><creatorcontrib>Kartas, A</creatorcontrib><creatorcontrib>Rampidis, G</creatorcontrib><creatorcontrib>Doundoulakis, I</creatorcontrib><creatorcontrib>Fotos, G</creatorcontrib><creatorcontrib>Efthimiadis, G</creatorcontrib><creatorcontrib>Karvounis, H</creatorcontrib><creatorcontrib>Tzikas, A</creatorcontrib><creatorcontrib>Giannakoulas, G</creatorcontrib><creatorcontrib>MISOAC-AF</creatorcontrib><title>Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation</title><title>European heart journal</title><description>Abstract Background Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence. Purpose To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged &lt;80 years and in those without history of heart failure (p for interaction &lt;0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p&lt;0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD. Conclusions Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis. Funding Acknowledgement Type of funding sources: None. 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Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence. Purpose To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged &lt;80 years and in those without history of heart failure (p for interaction &lt;0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p&lt;0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD. Conclusions Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis. Funding Acknowledgement Type of funding sources: None. Subgroup analyses by VHD statusPrognostic impact of valve lesions</abstract><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehab724.0421</doi><oa>free_for_read</oa></addata></record>
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title Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation
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