Clinical and prognosis assessment of Atrial Fibrillation patients with significant valvular disease. Validation of the EHRA valve classification (Evaluated Heartvalves. Rheumatic or Artificial)

Abstract

Abstract Introduction Historically, the definition of valvular heart disease in atrial fibrillation (AF) patients has been inconsistent. For this reason, in 2017 the EHRA proposed a more accurate classification, classifing AF patients in EHRA I (AF patients with mechanical prostheses or moderate/severe rheumatic mitral stenosis), EHRA II (includes the presence of significant valve disease, bioprosthetic valve replacement, TAVR – Transcatheter Aortic Valve Replacement – or mitraclip) and EHRA III (absence of valve involvement). Purpose The objective was to evaluate the prevalence of valve involvement in AF patients, clinical characteristics and adverse outcomes according to new EHRA classification, focusing in the EHRA II vs EHRA III comparison. Methods Observational, multicenter, retrospective study of stable anticoagulated AF patients was performed. Clinical, echocardiographic, demographic characteristics and adverse events after 2 years of follow-up were collected according to EHRA II vs EHRA III groups. Results 981 patients were analyzed: 755 (76.9%) classified as EHRA II [440 (56.8%) with native valve involvement, 134 (17.8%) with surgical biological prostheses and 181 (23.4%) with TAVR] and 226 (23.1%) as EHRAIII. Higher comorbidity profile was observed in the different EHRA II subgroups compared to patients with EHRA III (Table 1). After 2 years of follow-up, the occurrence of adverse events was higher in EHRA-II than EHRA III patients (Figure 1). In the Cox analysis, weo bserved that patients with native valve involvement and TAVR had up to 3 times higher risk of mortality [HR 3.32, (95% CI 1.88–5.85; p<0.001)], 2 times higher risk of Heart Failure [HR 2.14, (95 CI 1.30–3.5; p<0.001)] and MACE [HR 2.01, (95% CI 1.14–3.52; p<0.015)] than EHRA III patients. Conclusion The prevalence of valve involvement in patients with AF is high. Only 23% of AF patients did not present any valve disease. Patients with native valve involvement or TAVR had a high burden of comorbidities and cardiovascular risk factors. Patients with native involvement and TAVR also showed an 2.5-fold increased risk of adverse events during the follow-up. These findings highlight the increased risk related with the presence of valve disease in patients with AF. Funding Acknowledgement Type of funding sources: None.