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Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis study

Greve, Anders M.; Gerdts, Eva; Boman, Kurt; Gohlke-Baerwolf, Christa; Rossebo, Anne B.; Nienaber, Christoph A.; Ray, Simon; Egstrup, Kenneth; Pedersen, Terje R. and Kober, Lars, et al. (2013) In International Journal of Cardiology 166(1). p.72-76
Abstract
Background: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. Methods: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild-to-moderate AS and preserved left ventricular (LV) systolic function, randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. At inclusion, AF was categorized as episodic or longstanding. Rhythm change was assessed on annual in-study electrocardiograms. Impact of AF on cardiovascular morbidity and mortality was determined by adjusting for biomarkers, clinical- and echocardiographic... (More)
Background: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. Methods: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild-to-moderate AS and preserved left ventricular (LV) systolic function, randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. At inclusion, AF was categorized as episodic or longstanding. Rhythm change was assessed on annual in-study electrocardiograms. Impact of AF on cardiovascular morbidity and mortality was determined by adjusting for biomarkers, clinical- and echocardiographic covariates. Results: Mean follow-up was 4.3 +/- 0.8 years (6,721 patient-years of follow-up). At baseline, episodic AF was present in 87 patients (5.6%), longstanding AF in 55 (3.5%) and no AF in 1,421 (90.9%). Incidence of new-onset AF was 1.2%/year; highest in those with impaired LV function. In multivariable analysis, longstanding AF was compared to no AF at baseline, associated with a 4.1-fold higher risk of heart failure (CI 1.2 to 13.8, p = 0.02) and a 4.8-fold higher risk of non-hemorrhagic stroke (CI 1.7 to 13.6, p = 0.003). Conclusion: Rate of AF is moderate in asymptomatic AS. Longstanding but not episodic AF was, independently predictive of increased risk of heart failure and non-hemorrhagic stroke. New-onset AF was associated with cardiac decompensation. (c) 2011 Elsevier Ireland Ltd. All rights reserved. (Less)
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publication status
published
subject
keywords
Asymptomatic aortic stenosis, Atrial fibrillation, Outcome
in
International Journal of Cardiology
volume
166
issue
1
pages
72 - 76
publisher
Elsevier
external identifiers
  • wos:000318966300022
  • scopus:84877780409
ISSN
0167-5273
DOI
10.1016/j.ijcard.2011.09.064
language
English
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yes
id
c5396c41-797a-49c0-b29a-4c24ac3d8a15 (old id 3932403)
date added to LUP
2013-08-01 07:40:38
date last changed
2019-09-11 01:00:29
@article{c5396c41-797a-49c0-b29a-4c24ac3d8a15,
  abstract     = {Background: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. Methods: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild-to-moderate AS and preserved left ventricular (LV) systolic function, randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. At inclusion, AF was categorized as episodic or longstanding. Rhythm change was assessed on annual in-study electrocardiograms. Impact of AF on cardiovascular morbidity and mortality was determined by adjusting for biomarkers, clinical- and echocardiographic covariates. Results: Mean follow-up was 4.3 +/- 0.8 years (6,721 patient-years of follow-up). At baseline, episodic AF was present in 87 patients (5.6%), longstanding AF in 55 (3.5%) and no AF in 1,421 (90.9%). Incidence of new-onset AF was 1.2%/year; highest in those with impaired LV function. In multivariable analysis, longstanding AF was compared to no AF at baseline, associated with a 4.1-fold higher risk of heart failure (CI 1.2 to 13.8, p = 0.02) and a 4.8-fold higher risk of non-hemorrhagic stroke (CI 1.7 to 13.6, p = 0.003). Conclusion: Rate of AF is moderate in asymptomatic AS. Longstanding but not episodic AF was, independently predictive of increased risk of heart failure and non-hemorrhagic stroke. New-onset AF was associated with cardiac decompensation. (c) 2011 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Greve, Anders M. and Gerdts, Eva and Boman, Kurt and Gohlke-Baerwolf, Christa and Rossebo, Anne B. and Nienaber, Christoph A. and Ray, Simon and Egstrup, Kenneth and Pedersen, Terje R. and Kober, Lars and Willenheimer, Ronnie and Wachtell, Kristian},
  issn         = {0167-5273},
  keyword      = {Asymptomatic aortic stenosis,Atrial fibrillation,Outcome},
  language     = {eng},
  number       = {1},
  pages        = {72--76},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis study},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2011.09.064},
  volume       = {166},
  year         = {2013},
}