Prognostic significance of atrial fibrillation and severity of symptoms of heart failure in patients with low gradient aortic stenosis and preserved left ventricular ejection fraction
Abstract
The aims of this study were to investigate the clinical outcomes of patients with low-gradient aortic stenosis despite preserved left ventricular ejection fraction and to assess reliable prognostic clinical-instrumental features in patients experiencing or not experiencing aortic valve replacement (AVR). Clinical-laboratory and echocardiographic data from 167 patients (median age 78 years, interquartile range 69 to 83) with aortic valve areas <1.0 cm(2), mean gradients ≤30 mm Hg, and preserved left ventricular ejection fraction (≥55%), enrolled from 2005 to 2010, were analyzed. During a mean follow-up period of 44 ± 23 months, 33% of patients died. On multivariate analysis, independent predictors of death were baseline New York Heart Association functional class III or IV (hazard ratio 2.16, p = 0.038) and atrial fibrillation (hazard ratio 2.00, p = 0.025). Conversely, AVR was protective (hazard ratio 0.25, p = 0.01). The magnitude of the protective effect of AVR seemed to be relatively more important in patients with atrial fibrillation than in those in sinus rhythm, independently of the severity of symptoms. Age >70 years showed a trend toward being a prognostic predictor (p = 0.082). In conclusion, in patients with low-gradient aortic stenosis despite a preserved left ventricular ejection fraction, AVR was strongly correlated with a better prognosis. Patients with atrial fibrillation associated with advanced New York Heart Association class had the worst prognosis if treated medically but at the same time a relative better benefit from surgical intervention.
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AF worsens prognosis in patients with severe valvular heart disease, including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.
“AF worsens prognosis in patients with severe valvular heart disease, 256 including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [256]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
- Authors
- Moretti, M., Fabris, E., Morosin, M., Merlo, M., Barbati, G., Pinamonti, B., Gatti, G., Pappalardo, A., & Sinagra, G.
- Affiliations
- University of Trieste (IT)
- Corresponding author
- Fabris, Enrico
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 114
- Issue
- 11
- Pages
- 1722-1728
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2006610562
- Cited by
- 25
- References
- 10
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 5
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- low-gradient aortic stenosis, preserved ejection fraction, atrial fibrillation, heart failure symptoms, aortic valve replacement, prognosis, mortality, NYHA functional class, surgical versus medical management
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Anticoagulants, Aortic Valve, Aortic Valve Stenosis, Atrial Fibrillation, Calcium Channel Blockers, Cardiovascular Agents, Digoxin, Diuretics, Female, Follow-Up Studies, Nitroglycerin, Heart Failure, Humans, Male, Platelet Aggregation Inhibitors, Prognosis, Severity of Illness Index, Stroke Volume, Echocardiography, Doppler, Multivariate Analysis, Proportional Hazards Models, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Heart Valve Prosthesis Implantation
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