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 cm², 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 cm²/m²; 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/m²) 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.

中文翻译：

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严重主动脉瓣狭窄和房颤对窦性心律患者的血流动力学特征。

背景

在患有严重主动脉瓣狭窄（AS）的患者中，房颤（AF）与主动脉瓣置换（AVR）后的长期死亡率增加相关，这可能是由于AF的血液动力学不良所致。我们旨在分析重度AS和AF患者与窦性心律（SR）的血液动力学特征。

方法

我们对486例严重AS患者（索引主动脉瓣面积0.41±0.13 cm ²，左心室射血分数58±12％）的患者（74±10岁，男性58％）进行了心脏导管检查：50例患有AF，436例有SR。所有患者均接受外科手术（n  = 350）或经导管（n  = 136）AVR。

结果

尽管分度主动脉瓣面积相似（0.41±0.11 vs. 0.41±0.12 cm ² / m ²；p  = 0.45），AF患者的左心室射血分数较低，左心房面积较大，三尖瓣环平面收缩期偏低，平均肺部较高动脉压（34±13 vs. 24±9 mmHg），平均肺动脉楔压（mPAWP; 22±8 vs. 15±7 mmHg）和肺血管阻力（2.8±1.9 vs. 2.0±1.3 Wood unit）和比SR患者的卒中体积指数低（26±9 vs. 37±10 ml / m ²）（p 均<0.05）。AF和SR患者的mPAWP-左心室舒张末压（LVEDP）关系不同，AF中mPAWP较高，SR中LVEDP较高。在AVR术后AF患者（p  = 0.05）和mPAWP与LVEDP之间的差异较大（p  = 0.005）的患者中位随访49（四分位间距，35-64）个月后，死亡率更高。

结论

与SR伴有较差的临床预后的患者相比，严重AS和伴发AF的患者的血流动力学特征明显不同，且显着更差。