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：

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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。