Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-07-31 DOI:10.1002/clc.70172

Antonio Escolar Conesa, María Asunción Esteve-Pastor, Vanessa Roldán, Eva Soler Espejo, José Miguel Rivera-Caravaca, Pablo Gil Pérez, Eduardo González Lozano, José María Arribas Leal, Sergio Cánovas López, Daniel Saura Espín, María José Oliva Sandoval, Eduardo Pinar Bermúdez, Juan García De Lara, Gregory Y. H. Lip, Francisco Marín

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Abstract

Background

Atrial fibrillation (AF) in association with native valvular heart disease (VHD) is very common and both entities perpetuate each other due to volume and pressure overload. In 2017, the new EHRA classification (Evaluated Heartvalves, Rheumatic or Artificial) was proposed: EHRA 1 (mechanical prostheses or moderate/severe mitral stenosis), EHRA 2 (native valvular involvement or biological prosthesis) and EHRA 3 (without valve disease). The objective was to analyze the clinical characteristics as well as adverse events in the follow-up of AF patients under oral anticoagulation classified according EHRA classification.

Methods

A multicenter retrospective observational descriptive study was designed and collected clinical, analytical, echocardiographic characteristics as well as adverse events in the follow-up of patients with AF who start oral anticoagulation.

Results

1.399 patients were included (mean age 75.3 ± 9.9 years; 659 (47.1%) male), of whom, 63% were classified as EHRA 2. After a median follow-up of 910 (IQR 730−1018) days, native EHRA 2 patients had higher event rates/patient-year as well as a higher total rate of adverse events such as cardiovascular mortality (5.5% vs. 1.1% event/patient-year; 8.7% vs. 1.1% p < 0.001) and major adverse cardiovascular events (MACE) (8.9% vs. 3.4% event/patient-year; 14.2% vs. 3.1% p < 0.001), compared with EHRA 3 patients. Multivariate logistic regression analysis showed that native EHRA 2 group was independently associated with all major adverse events.

Conclusion

In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for all-cause mortality, major bleeding, cardiovascular mortality, ACS, heart failure, and MACE.

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使用EHRA（评估心瓣膜、风湿性或人工）分类评估心房颤动患者存在先天性瓣膜疾病

背景房颤（AF）与先天性瓣膜性心脏病（VHD）相关是非常常见的，由于容量和压力过载，这两种疾病相互延续。2017年，提出了新的EHRA分类（评估心脏瓣膜，风湿性或人工）：EHRA 1（机械假体或中度/重度二尖瓣狭窄），EHRA 2（天然瓣膜受累或生物假体）和EHRA 3（无瓣膜疾病）。目的分析按EHRA分级口服抗凝治疗的房颤患者的临床特点及随访不良事件。方法设计多中心回顾性观察性描述性研究，收集房颤患者口服抗凝治疗后的临床、分析、超声心动图特征及随访不良事件。结果纳入患者1.399例(平均年龄75.3±9.9岁；659例（男性47.1%），其中63%为EHRA 2级。中位随访910 （IQR 730 - 1018）天后，原生EHRA 2患者的事件发生率/患者-年更高，心血管死亡率等不良事件的总发生率也更高(5.5% vs 1.1%事件/患者-年；8.7% vs. 1.1% p < 0.001)和主要不良心血管事件（MACE） (8.9% vs. 3.4%事件/患者-年；14.2%对3.1% p < 0.001)，与EHRA 3型患者相比。多因素logistic回归分析显示，原生EHRA 2组与所有主要不良事件独立相关。结论在抗凝房颤患者中，先天性瓣膜受累（EHRA 2）患者预后较无瓣膜受累（EHRA 3）患者差。原生瓣膜疾病的存在是全因死亡率、大出血、心血管死亡率、ACS、心力衰竭和MACE的独立危险因素。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.