Background: Atrial fibrillation (AF) is common in patients with aortic stenosis (AS) although the exact mechanism is unclear. The purpose of this study was to investigate echocardiographic characteristics among patients with severe AS and AF and to identify factors associated with the development of new-onset AF after aortic valve replacement (AVR). Methods: 125 patients with severe AS and ejection fraction N 40% scheduled for AVR were evaluated preoperatively and 3, 6, 9 and 12 months postoperatively with electrocardiography (ECG) and echocardiography, and Holter-ECG analysis was performed after 3 and 12 months. The primary endpoint was new-onset AF defined as an episode of AF exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalized due to AF. Results: AF was present in 19 patients prior to AVR, compared to patients in sinus rhythm AF patients had increased NT-proBNP, increased left atrial (LA) volume (61 ± 21 vs. 47 ± 17 ml/m 2 , p = 0.002), reduced global longitudinal left ventricular strain (−13.1 ± 3.7 vs. −16.0 ± 3.5, p = 0.002) and presented more often with a restrictive filling pattern (37% vs. 10%, p = 0.002). During follow-up 23 patients developed new-onset AF; predictors were LA volume, restrictive filling pattern, NT-proBNP, E/e′ and systolic blood pressure. After correcting for age and LA volume index, a restrictive filling pattern and systolic blood pressure remained associated with new-onset AF. Conclusions: The presence of preoperative AF and development of new-onset AF after AVR is associated with restrictive filling pattern and LA dilatation in patients with severe AS.
Background 2D speckle tracking (2DSE) has been recently used as an advanced method for assessment of left atrial (LA) function. Purpose The aim of the study was to determine the association between LA function assessed with 2DSE and severity of mitral regurgitation, filling pressures and symptomatic status in patients with primary mitral regurgitation (MR). Methods 61 patients (age 65 ± 9 years, 77% males) with primary mitral prolapse and moderate to severe MR (effective regurgitant orifice (ERO) > 0.30 cm2) and left ventricular ejection fraction > 60% were enrolled. Right heart catheterization during rest and exercise, and transthoracic echocardiography during rest was performed. Pulmonary capillary wedge pressure (PCWP) was measured at rest and peak exercise. Echocardiographic average values of LA peak contractile, conduit and reservoir strain were obtained using 2DSE in the apical 4 and 2 chamber views. Results LA volume index was less than 34 ml/m2 in 54 patients, and LA function based on 2DSE was abnormal in majority. LA function was associated with ERO (Figure). Patients with severe MR defined as ERO > 0.40 cm2 had significant higher reservoir strain (27.5 ± 5.1% vs. 24.5 ± 5.1 %, p = 0.02) and conduit strain (16.0 ± 4.9 %, vs. 13.1 ± 3.2 %, p = 0.008), but LA peak contractile strain was unchanged (11.4 ± 3.4 % vs. 11.8 ± 3.5 %, p = 0.69). In contrast no association between LA function, symptoms and PCWP at rest or exercise was found in our cohort. In linear regression analysis MR (ERO > 0.40 cm2) was associated with conduit (β=2.8, p = 0.02) and reservoir strain (β=3.0, p = 0.04) after adjustment for age, gender, symptoms and PCWP with exercise, whereas LA peak contractile was not. Conclusions LA function assessed with 2DSE was affected in patients with primary MR. Strain parameters were associated with severity of mitral regurgitation, but there was no association with symptomatic status or filling pressure at rest or exercise. Abstract P1785 Figure
Background Heart failure (HF) is a progressive disease characterized by risk of congestion and often accompanied by a significant burden of comorbidities. At the time of HF diagnosis, these are associated with a poor outcome, but it is relatively unknown whether hospitalization due to new-onset comorbidities carries the same subsequent mortality risk as hospitalization for worsening HF. Purpose To assess one-year mortality risk after hospitalization due to new-onset chronic comorbidity compared to a hospitalization with worsening HF in a nationwide cohort of patients with HF. Methods In Danish administrative registers, we identified all patients, aged 40–95 years with a first-time HF diagnosis from 2000 through 2016. Patients were included if they survived the initial 120 days and collected prescribed renin-angiotensin system inhibitor and beta-blocker. In analyses stratified on age and baseline burden of comorbidity (based on Charlson Comorbidity Index (CCI) excluding myocardial infarction and HF, we estimated absolute one-year mortality risk continuously during follow-up, using landmarking and flexible semi-parametric methods. If a patient had a comorbidity hospitalization equivalent to an increase in his/ her CCI or a HF hospitalization, one-year mortality risk was estimated immediately hereafter. In analyses assuming constant risks during follow-up, we calculated absolute risks and risk ratios for new comorbidity- or HF hospitalizations compared to patients without events. Results We included 81,788 patients, median age 72 (Q1-Q3:63–80), 36% women. At baseline, 57% had CCI=0, 22% CCI=1, 9% CCI=2 and 12% CCI≥3. High age and baseline CCI were associated with increased mortality risk throughout follow-up. Both new comorbidity- and HF hospitalizations at any time during follow-up were associated with increased mortality risk (p<0.001) (Figure), and the risk was approximately constant over time. Among patients with baseline CCI=0, new-onset comorbidity (incident increase in CCI) was associated with a higher mortality risk than a HF hospitalization in all age groups, risk ratios with “no event” as reference: Age 40–64: 5.4 (95%-CI: 4.5–6.4) vs 2.5 (95%-CI: 2.1–2.9); age 65–74: 4.2 (95%-CI: 3.7–4.7) vs 2.2 (95%-CI: 1.9–2.5); age 75–84: 3.4 (95%-CI: 3.2–3.7) vs 2.3 (95%-CI: 2.1–2.5) and age 85–95: 2.6 (95%-CI: 2.4–2.8) vs 2.2 (95%-CI: 2.0–2.4) (figure). Across all strata, new-onset comorbidity was associated with at least similar risk as a HF hospitalization at any time during follow-up. Conclusions For patients with HF, hospitalization for new-onset chronic comorbidity was associated with at least the same mortality risk as worsening HF, independently of age. This finding highlights the prognostic impact of comorbidity for patients with HF and warrants further investigations in the mechanisms underlying the mortality. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation
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