Jordi S. Dahl , Axel Brandes , Lars Videbæk , Mikael K. Poulsen , Rasmus Carter-Storch , Nicolaj Lyhne Christensen , Ann B. Banke , Patricia A. Pellikka , Jacob E. Møller
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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.</p></div><div><h3>Results</h3><p>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<sup>2</sup>, 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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":90542,"journal":{"name":"International journal of cardiology. Heart & vessels","volume":"4 ","pages":"Pages 102-107"},"PeriodicalIF":0.0000,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ijchv.2014.06.006","citationCount":"12","resultStr":"{\"title\":\"Atrial fibrillation in severe aortic valve stenosis — Association with left ventricular left atrial remodeling\",\"authors\":\"Jordi S. Dahl , Axel Brandes , Lars Videbæk , Mikael K. Poulsen , Rasmus Carter-Storch , Nicolaj Lyhne Christensen , Ann B. Banke , Patricia A. Pellikka , Jacob E. Møller\",\"doi\":\"10.1016/j.ijchv.2014.06.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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).</p></div><div><h3>Methods</h3><p>125 patients with severe AS and ejection fraction > 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.</p></div><div><h3>Results</h3><p>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<sup>2</sup>, 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. 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引用次数: 12
摘要
背景:心房颤动(AF)在主动脉瓣狭窄(AS)患者中很常见,但其确切机制尚不清楚。本研究的目的是探讨严重AS和房颤患者的超声心动图特征,并确定主动脉瓣置换术(AVR)后新发房颤的相关因素。方法对125例重度AS患者的射血分数进行分析;术前、术后3个月、6个月、9个月、12个月分别进行心电图和超声心动图评估,3个月和12个月分别进行动态心电图分析。主要终点是新发房颤,定义为房颤发作超过30秒,心电图或holt -ECG和/或因房颤住院的患者。结果与窦性心律房颤患者相比,AVR前有19例患者存在房颤,患者NT-proBNP增加,左房(LA)容积增加(61±21比47±17 ml/m2, p = 0.002),整体左室纵向应变减少(- 13.1±3.7比- 16.0±3.5,p = 0.002)。P = 0.002),更常出现限制性填充模式(37% vs. 10%, P = 0.002)。随访期间,23例患者出现新发房颤;预测因子为LA容积、限制性充盈模式、NT-proBNP、E/ E′和收缩压。在校正了年龄和LA容积指数后,限制性充盈模式和收缩压仍与新发房颤相关。结论严重AS患者术前房颤的存在和AVR后新发房颤的发展与限制性充盈模式和LA扩张相关。
Atrial fibrillation in severe aortic valve stenosis — Association with left ventricular left atrial remodeling
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 > 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/m2, 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.