SPC365

AF in TAVR patients: double trouble means double care

Session: Comunicações Orais - Sessão 23 - Intervenção Valvular Aórtica Percutânea
Speaker: Catarina Gregório

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Pedro Alves da Silva; Beatriz Valente Silva; Joana Brito; Ana Margarida Martins; Ana Beatriz Garcia; Catarina Simões de Oliveira; Ana Abrantes; Miguel Azaredo Raposo; João Santos Fonseca; Miguel Nobre Menezes; João Silva Marques; Cláudia Jorge; Pedro Carrilho Ferreira; Fausto J. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#212121"><span style="background-color:#ffffff"><strong>Introduction</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#212121"><span style="background-color:#ffffff">: Atrial fibrillation (AF) and aortic stenosis share multiple common risk factors and aortic valve stenosis itself is associated with a higher rate of AF. Patients submitted to transcatheter aortic valve replacement (TAVR) are particularly frail and AF</span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff"> is associated with increased mortality, ischemic and hemorrhagic events. Thus, a thorough approach, especially in such a frail population, is warranted to reduce morbi-mortality. Bearing this in mind, a risk assessment tool derived from ENVISAGE-AF trial was recently developed to stratify the mortality risk of AF patients after completion of successful TVR.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff"><strong>Purpose: </strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">To characterize a population of patients with AF who implanted TAVR and test a newly proposed mortality score to estimate prognosis in this population.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff"><strong>Methods</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">: Single-center observational retrospective study including consecutive pts with AF who implanted TAVI from 2017 to 2021. Clinical data was collected at baseline and during follow-up. The AF mortality score groups pts in three crescent strata of severity (0-10; 11-16; &gt;16) by summing seven variables: age, creatinine clearance, duration of AF, NYHA class, alcohol consumption, peripheral artery disease and prior major bleeding. Kaplan Meyer survival analysis was performed using SPSS statistics.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff"><strong>Results</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">: For 5 years, 621 pts underwent TAVR, of which 189 (30,4%) had previously diagnosed AF. 102pts were female, mean age of 82,6&plusmn; 6,1 years. More than half (53%) had permanent AF, 28% paroxysmal AF and 19% persistent AF.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">During a mean follow up of 953 days, 8 (4,2%) pts suffered a major hemorrhagic event, two pts had ischemic arterial events (peripheral and mesenteric) and no venous thrombotic events were observed. As anticipated, the event rate was high: at 1 year follow-up, 27 were admitted for cardiovascular events (3 with acute myocardial infarction and 4 with stroke). 26 pts died after 1-year (13,7%) and 30 died during available FUP (15,8%).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">The aforementioned AF mortality score was applied to our pts at baseline, before TAVR: 63%, 17.5% and 8.5% of patients were categorized as low, moderate or high risk. Patients in the high risk group (score&gt;16) had a significantly higher rate of events during follow-up &ndash; figure1. Lower and intermediate groups failed to show a clear separation in terms of risk estimation between them, which may be attributed to the paucity of events in these two groups.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff"><strong>Conclusion: </strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#2a2a2a"><span style="background-color:#ffffff">AF and aortic stenosis are both burdensome diseases and AF increases the risk of events in the TAVR population. We showed that a newly proposed score that stemmed from ENVISAGE-AF can effectively select pts at high risk of mortality, in whom close clinical surveillance should be particularly rigorous.</span></span></span></span></p>