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High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation
Circulation: Cardiovascular Imaging ( IF 6.5 ) Pub Date : 2021-07-12 , DOI: 10.1161/circimaging.120.012453
Said Alsidawi 1, 2 , Sana Khan 1, 3 , Sorin V Pislaru 1 , Jeremy J Thaden 1 , Edward A El-Am 1, 4 , Christopher G Scott 5 , Kareem Morant 1, 6 , Didem Oguz 1 , Sushil A Luis 1 , Ratnasari Padang 1 , Colleen E Lane 1 , Robert B McCully 1 , Patricia A Pellikka 1 , Jae K Oh 1 , Vuyisile T Nkomo 1
Affiliation  

Background:Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS).Methods:One thousand five hundred forty-one patients with aortic valve area ≤1 cm2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed.Results:Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581–3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978–4229, P=0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817–2810, P=0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945–1832, P<0.001); AVCS in AF-LGAS were higher when HS were present (P=0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40–2.36], P<0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04–2.26], P=0.03) but not different in AF-LGAS without HS or SR-LGAS (both P=not significant).Conclusions:Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.

中文翻译:

与心房颤动相关的低流量状态下严重主动脉瓣狭窄的高患病率

背景:心房颤动 (AF) 是一种低流量状态,可能会低估主动脉瓣狭窄 (AS) 的严重程度。在目前的实践中,与严重 AS(峰值速度≥4 m/s 或平均梯度≥40 mm Hg)一致的单高多普勒信号 (HS) 被平均下来。本研究的目的是确定 HS 在 AF 低梯度 AS (LGAS) 中的显着性。方法:1541 名主动脉瓣面积≤1 cm 2 的患者和左心室射血分数 ≥ 50% 被确定并分类为高梯度 AS (HGAS) (≥40 mm Hg) 和 LGAS (<40 mm Hg),以及 AF 与窦性心律 (SR)。从病历中检索可用的计算机断层扫描主动脉瓣钙化评分 (AVCS)。评估结果。结果:平均年龄为 76±11 岁,女性 47%。SR-HGAS 的平均梯度为 51±12,AF-HGAS 为 48±10,SR-LGAS 为 31±5,AF-LGAS 为 29±7 mm Hg,与 SR-HGAS 相比,所有P ≤0.001;HS 存在于 33% 的 AF-LGAS 中。AVCS 有 34% 可用。与 SR-HGAS(2409 个任意单位;四分位距,1581-3462)相比,AF-HGAS 的 AVCS 更高(2991 个任意单位;IQR1978-4229,P =0.001),在 AF-LGAS 中没有差异(2399 个任意单位;IQR1817) –2810, P=0.47),在 SR-LGAS 中更低(1593 个任意单位;IQR945-1832,P <0.001);当 HS 存在时,AF-LGAS 的 AVCS 更高(P = 0.048)。与 SR-HGAS 相比,AF-HGAS 的年龄、性别、合并症指数和时间依赖性主动脉瓣置换调整的死亡风险更高(风险比 = 1.82 [1.40–2.36],P <0.001)和AF-LGAS 伴 HS(风险比 = 1.54 [1.04-2.26],P = 0.03)但在没有 HS 或 SR-LGAS 的 AF-LGAS 中没有差异(P = 不显着)。结论:严重的 AS 常见于 AF- LGAS。AF-LGAS 中的 AVCS 与 SR-HGAS 没有区别。当 HS 存在时,AF-LGAS 的 AVCS 更高,死亡率更差。
更新日期:2021-07-21
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