title: Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis: the Simvastatin and Ezetimibe in Aortic Stenosis study.
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).
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark. greve_anders@hotmail.com
authors: Anders M
authors: AM
authors: Greve
authors: Eva
authors: E
authors: Gerdts
authors: Kurt
authors: K
authors: Boman
authors: Christa
authors: C
authors: Gohlke-Baerwolf
authors: Anne B
authors: AB
authors: Rossebø
authors: Christoph A
authors: CA
authors: Nienaber
authors: Simon
authors: S
authors: Ray
authors: Kenneth
authors: K
authors: Egstrup
authors: Terje R
authors: TR
authors: Pedersen
authors: Lars
authors: L
authors: Køber
authors: Ronnie
authors: R
authors: Willenheimer
authors: Kristian
authors: K
authors: Wachtell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D058070:Asymptomatic Diseases / Q000453:epidemiology / Q000628:therapy*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D001384:Azetidines / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D000069499:Ezetimibe, Simvastatin Drug Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019821:Simvastatin / Q000008:administration & dosage*
chemical_list: D001384:Azetidines; D004338:Drug Combinations; D000069499:Ezetimibe, Simvastatin Drug Combination; D019821:Simvastatin