Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Samaras, Athanasios; Vrana, Eleni; Κάρτας, Αναστάσιος; Moysidis, Dimitrios V.; Papazoglou, Αndreas S.; Doundoulakis, Ioannis; Fotos, G; Rampidis, Georgios; Tsalikakis, Dimitrios G.; Efthimiadis, Georgios K.; Karvounis, Haralambos; Giannakoulas, George

doi:10.1186/s12872-021-02264-3

Cited by 4 publications

(6 citation statements)

References 37 publications

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“…It is well-known to coexist with comorbidities, such as coronary artery disease (CAD), heart failure (HF), valvular heart disease, arterial hypertension, chronic kidney disease, and diabetes mellitus (DM). [6][7][8] AF-related medications are considered high risk regarding side effects and interactions. Prior studies suggest increased mortality and morbidity rates along with an increased pill burden in patients with AF.…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and major adverse events in atrial fibrillation

Tsagkaris

Papazoglou

Κάρτας

et al. 2022

Journal of Cardiovascular Pharmacology

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Patients with atrial fibrillation (AF) often receive multiple medications daily. The purpose of this study was to examine the prognostic implications of polypharmacy in patients with AF. This is a retrospective post hoc analysis of 1113 AF patients, enrolled in a randomized trial during an acute hospitalization (MISOAC-AF, NCT02941978). The presence of polypharmacy (use of .4 drugs daily) was assessed at hospital discharge. Regression analyses were performed to identify clinical predictors of polypharmacy and compare the outcomes of patients with or without confirmed polypharmacy. The coprimary outcomes were all-cause and cardiovascular (CV) mortality. Among patients with polypharmacy, the difference in the risk of mortality was also assessed per each added drug as a numeric variable. Polypharmacy was found in 36.9% of participants. Dyslipidemia, coronary artery disease, lower left ventricular ejection fraction, and higher glomerular filtration rates were independent predictors of polypharmacy. Polypharmacy was an independent predictor for all-cause death (adjusted hazard ratio [aHR]: 1.29, 95% confidence interval [CI]: 1.01-1.64) and CV death (aHR: 1.39, 95% CI: 1.05-1.84). Among patients with polypharmacy, each additional concomitant medication was independently associated with a 4% increased risk of all-cause mortality (aHR = 1.04, 95% CI: 1.00-1.08) and a 5% increased risk of CV mortality (aHR = 1.05, 95% CI: 1.00-1.10). Polypharmacy was common among patients with AF hospitalized in a tertiary hospital and was incrementally associated with higher rates of mortality.

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Section: Introductionmentioning

confidence: 99%

Polypharmacy and major adverse events in atrial fibrillation

Tsagkaris

Papazoglou

Κάρτας

et al. 2022

Journal of Cardiovascular Pharmacology

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“…In another selected AF cohort with at least moderate TR, during a median period of 52 months, the severity of AF-TR was indicative of all-cause mortality [ 25 ]. A post-hoc analysis of MISOAC-AF trial analyzing valvular heart disease in AF patients also confirmed the association of TR with mortality [ 26 ].…”

Section: Discussionmentioning

confidence: 85%

“…Both Dietz et al [ 24 ] and Prapan et al [ 23 ] evaluated composite end-points as adverse events, not mortality alone. Fortuni et al [ 25 ] referred to only a subset of severe TR, respectively, torrential AF-TR, as a driver of mortality, while Samaras et al [ 26 ] evaluated severe TR of all etiologies, not specifically AF-TR.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is among the scarce proof of the independent prognostic impact of AF-TR in AF patients Until recently, TR was an underestimated and neglected entity, considered almost exclusively a consequence of left heart disorders or pulmonary disease, without intrinsic prognostic value. Currently, there is a positive trend toward recognition of the AF-TR in AF patients and its prognostic value [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients

Vijan

Daha

Delcea

et al. 2022

JCM

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Background and Aim: Atrial fibrillation (AF) is an epidemic disease with a significant global health impact. Atrial functional tricuspid regurgitation (AF-TR) is a more recently acknowledged complication of AF. The main purpose of this study was to determine the prognostic value of severe AF-TR in patients with AF, and its determinants. Methods: In this retrospective, observational study, we included AF patients admitted consecutively to a tertiary clinical hospital between January 2018 and February 2020, irrespective of cause of hospitalization. Patients with organic TR, significant pulmonary hypertension, left ventricular ejection fraction < 50%, those with implanted cardiac devices and those with in-hospital mortality were excluded. Severe TR was defined according to current guidelines. Median follow-up time was 34 (28–39) months. Primary endpoint was all-cause mortality. Results: We included 246 AF patients, with a mean age of 71.5 ± 9.4 years. 86.2% had AF-TR, while 8.1% had severe AF-TR. Mortality rate was 8.5%. Right atrial diameter (p = 0.005), systolic pulmonary artery pressure (sPAP) (p = 0.015) and NT-proBNP (p = 0.026) were independent predictors for the presence of severe valvular dysfunction. In multivariable survival analysis, severe AF-TR, was an independent predictor of all-cause mortality (HR 5.4, 95% CI 1.1–26.2, p = 0.035). Conclusion: Severe AF-TR was an independent predictor of mortality in AF patients, while mild/moderate AF-TR apparently had no impact on prognosis.

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“…VHD is mainly manifested as valve stenosis or insufficiency, which is the main cause of impaired activity tolerance, heart failure, and death in patients ( 11 ). According to epidemiological statistics in British, at least 50% of people over the age of 65 suffered from VHD ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Genetically Predicted Atrial Fibrillation and Valvular Heart Disease: A Two-Sample Mendelian Randomization Study

Gao

Bai

2022

Front. Cardiovasc. Med.

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BackgroundPrevious studies have found atrial fibrillation (AF) is associated with valvular heart disease (VHD). However, whether there is a causal relationship between these two diseases or it is just a result of bias caused by confounding factors is uncertain. This study aims to examine the potential causal association between AF and VHD by using Mendelian randomization.MethodsIn order to examine the causal relationship between AF and VHD, we performed a two-sample Mendelian randomization study by collecting exposure and outcome data from genome-wide association study (GWAS) datasets. We utilized data from FinnGen project (FinnGen, 11,258 cases for VHD including rheumatic fever, 3,108 cases for non-rheumatic VHD, and 75,137 cases for participants) and European Bio-informatics Institute database (EBI, 55,114 cases for AF and 482,295 cases for participants). Inverse-variance weighted (IVW), MR-Egger, and weighted median approaches were performed to estimate the causal effect.ResultsThe Mendelian randomization analysis indicated that AF increased the risk of VHD by all three MR methods [For VHD including rheumatic fever: IVW, odds ratio (OR) = 1.255; 95% confidence interval (CI), 1.191~1.322; p = 1.23 × 10−17; Weighted median, OR = 1.305, 95% CI, 1.216~1.400, p = 1.57 × 10−13; MR-Egger, OR = 1.250, 95% CI, 1.137~1.375, p = 1.69 × 10−5; For non-rheumatic VHD: IVW, OR = 1.267; 95% CI, 1.169~1.372; p = 6.73 × 10−9; Weighted median, OR = 1.400; 95% CI, 1.232~1.591; p = 2.40 × 10−7; MR-Egger, OR = 1.308; 95% CI, 1.131~1.513; p = 5.34 × 10−4]. After the one outlier SNP was removed by heterogeneity test, the results remained the same. No horizontal pleiotropic effects were observed between AF and VHD.ConclusionsOur study provides strong evidence of a causal relationship between AF and VHD. Early intervention for AF patients may reduce the risk of developing into VHD.

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Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Cited by 4 publications

References 37 publications

Polypharmacy and major adverse events in atrial fibrillation

Polypharmacy and major adverse events in atrial fibrillation

Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients

Genetically Predicted Atrial Fibrillation and Valvular Heart Disease: A Two-Sample Mendelian Randomization Study

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