Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF. 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. In total, 983 patients with non-valvular AF (median age 76 [14] years) were analyzed over a median follow-up period of 32 [20] months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 6.5%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p = 0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR 1.70, 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 < 80 years and in those without history of heart failure (p for interaction < 0.05, in both subgroups). After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization. Among patients with non-valvular AF, sVHD was highly prevalent and beared high prognostic value across a wide spectrum of clinical outcomes, especially in patients aged < 80 years or in the absence of heart failure. Predominantly AS, as well as MR and TR, were associated with worse prognosis.

中文翻译：

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瓣膜性心脏病对非瓣膜性房颤患者的预后影响


非瓣膜性心房颤动 (AF) 中的瓣膜性心脏病 (VHD) 是一个令人费解的临床疾病。本研究的目的是评估显着 VHD (sVHD) 对非瓣膜性 AF 患者的预后影响。这是 MISOAC-AF 试验 (NCT02941978) 的事后分析。纳入连续接受超声心动图检查的非瓣膜性房颤住院患者。 sVHD 被定义为至少存在中度主动脉瓣狭窄 (AS) 或主动脉/二尖瓣/三尖瓣反流 (AR/MR/TR)。带有协变量调整的 Cox 回归分析用于结果预测。总共对 983 名非瓣膜性 AF 患者（中位年龄 76 [14] 岁）进行了中位随访 32 [20] 个月的分析。 575 名 (58.5%) AF 患者被诊断为 sVH​​D。 sVHD 与全因死亡率（21.6%/年 vs. 6.5%/年；调整后 HR [aHR] 1.55，95% 置信区间 [CI] 1.17–2.06；p = 0.02）、心血管死亡率（16%/年）相关与 4%/年；aHR 1.70，95% CI 1.09–2.66；p = 0.02）和心力衰竭住院（5.8%/年与 1.8%/年；aHR 2.53，95% CI 1.35-4.63；p = 0.02）。 sVHD 的预后效应在 < 80 岁患者和无心力衰竭病史的患者中尤其明显（两个亚组中，交互作用 p < 0.05）。多变量调整后，中度/重度 AS 和 TR 与死亡率相关，而 AS 和 MR 与心力衰竭住院相关。在非瓣膜性 AF 患者中，sVHD 非常普遍，并且在广泛的临床结果中具有很高的预后价值，特别是在 < 80 岁或没有心力衰竭的患者中。主要是 AS，以及 MR 和 TR，与较差的预后相关。