{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:38:52Z","timestamp":1788183532505,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>There is limited evidence on the prognostic significance of atrial fibrillation (AF) in patients with low flow, low-gradient aortic stenosis with preserved ejection fraction (LFLG-pEF AS). We aimed to evaluate the recovery of stroke volume after transcatheter aortic valve implantation (TAVI) and clinical outcomes in patients with LFLG-pEF AS stratified by presence or absence of AF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In a prospective TAVI registry, patients with preserved left ventricular ejection fraction (LVEF\u00a0\u2265\u00a050%) were stratified according to flow-gradient status and presence of AF. Among 2259 TAVI patients with preserved LVEF between August 2007 and June 2021, 765 had high-gradient AS (HG AS) and 444 had LFLG-pEF AS. AF was observed in 199 patients with HG AS (26.0%) and 190 patients with LFLG-pEF AS (42.8%). At 1 year, stroke volume index (SVi) was significantly improved in LFLG-pEF AS patients without AF, while SVi remained low in patients with AF (from 25.9\u00a0\u00b1\u00a08.5\u00a0mL\/m2 to 37.2\u00a0\u00b1\u00a09.9\u00a0mL\/m2 and from 26.8\u00a0\u00b1\u00a05.1\u00a0mL\/m2 to 26.1\u00a0\u00b1\u00a09.1\u00a0mL\/m2, respectively). LFLG-pEF AS patients with AF had an increased risk of 1-year all-cause mortality compared with those without AF (adjusted hazard ratio (HRadjusted) 2.57; 95% confidence interval [CI] 1.44\u20134.59). LFLG-pEF AS patients without AF had similar mortality compared with HG AS patients without AF (HRadjusted 0.85; 95% CI 0.49\u20131.46).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with LFLG-pEF AS and AF experienced no relevant recovery of stroke volume after TAVI, but a more than two-fold increased risk of death compared to patients with HG AS or LFLG-pEF AS without AF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trial Registration<\/jats:title>\n                  <jats:p>https:\/\/www.clinicaltrials.gov. NCT01368250.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcad045","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T03:43:18Z","timestamp":1690342998000},"page":"246-255","source":"Crossref","is-referenced-by-count":6,"title":["Association of atrial fibrillation with survival in patients with low-flow low-gradient aortic stenosis with preserved ejection fraction undergoing TAVI"],"prefix":"10.1093","volume":"10","author":[{"given":"Masaaki","family":"Nakase","sequence":"first","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daijiro","family":"Tomii","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8766-7945","authenticated-orcid":false,"given":"Dik","family":"Heg","sequence":"additional","affiliation":[{"name":"CTU Bern, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5416-165X","authenticated-orcid":false,"given":"Fabien","family":"Praz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Stortecky","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5035-6625","authenticated-orcid":false,"given":"Jonas","family":"Lanz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3317-6219","authenticated-orcid":false,"given":"David","family":"Reineke","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4488-1335","authenticated-orcid":false,"given":"Stephan","family":"Windecker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8721-4068","authenticated-orcid":false,"given":"Thomas","family":"Pilgrim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern 3010 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"2024052309210865700_bib1","doi-asserted-by":"crossref","first-page":"2645","DOI":"10.1093\/eurheartj\/ehw096","article-title":"Low-gradient aortic stenosis","volume":"37","author":"Clavel","year":"2016","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib2","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1161\/CIRCULATIONAHA.113.003695","article-title":"Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival","volume":"128","author":"Eleid","year":"2013","journal-title":"Circulation"},{"key":"2024052309210865700_bib3","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.jacc.2013.05.044","article-title":"Impact of low flow on the outcome of high-risk patients undergoing transcatheter aortic valve replacement","volume":"62","author":"Le Ven","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2024052309210865700_bib4","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jcmg.2016.12.028","article-title":"Prognostic impact of low-flow severe aortic stenosis in small-body patients undergoing TAVR: the OCEAN-TAVI registry","volume":"11","author":"Kataoka","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024052309210865700_bib5","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.jcin.2019.01.233","article-title":"1-Year survival after TAVR of patients with low-flow, low-gradient and high-gradient aortic valve stenosis in matched study populations","volume":"12","author":"Fischer-Rasokat","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib6","doi-asserted-by":"crossref","first-page":"e008792","DOI":"10.1161\/CIRCINTERVENTIONS.119.008792","article-title":"Outcome of flow-gradient patterns of aortic stenosis after aortic valve replacement: an analysis of the PARTNER 2 trial and registry","volume":"13","author":"Salaun","year":"2020","journal-title":"Circ Cardiovasc Interv"},{"key":"2024052309210865700_bib7","doi-asserted-by":"crossref","first-page":"e010042","DOI":"10.1161\/CIRCINTERVENTIONS.120.010042","article-title":"Benefit of transcatheter aortic valve replacement in patients with paradoxical low-flow low-gradient versus high-gradient aortic stenosis and preserved left ventricular function","volume":"14","author":"Mosleh","year":"2021","journal-title":"Circ Cardiovasc Interv"},{"key":"2024052309210865700_bib8","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0735-1097(97)00254-4","article-title":"Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation","volume":"30","author":"Clark","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"2024052309210865700_bib9","doi-asserted-by":"crossref","first-page":"e012453","DOI":"10.1161\/CIRCIMAGING.120.012453","article-title":"High prevalence of severe aortic stenosis in low-flow State associated with atrial fibrillation","volume":"14","author":"Alsidawi","year":"2021","journal-title":"Circ Cardiovasc Imaging"},{"key":"2024052309210865700_bib10","first-page":"1285","article-title":"Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome","volume":"38","author":"Tarantini","year":"2017","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib11","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1016\/j.jcin.2019.06.019","article-title":"Impact of pre-existing and new-onset atrial fibrillation on outcomes after transcatheter aortic valve replacement","volume":"12","author":"Mentias","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib12","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1093\/ehjqcco\/qcy048","article-title":"Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis","volume":"5","author":"Stortecky","year":"2019","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2024052309210865700_bib13","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the management of patients with valvular Heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume-title":"Circulation","author":"Otto","year":"2021"},{"key":"2024052309210865700_bib14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib15","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1016\/j.jcin.2020.05.049","article-title":"Valvular and nonvalvular atrial fibrillation in patients undergoing transcatheter aortic valve replacement","volume":"13","author":"Okuno","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2024052309210865700_bib17","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1016\/j.jcin.2021.07.030","article-title":"Potential candidates for transcatheter tricuspid valve intervention after transcatheter aortic valve replacement: predictors and prognosis","volume":"14","author":"Tomii","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib18","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.echo.2009.07.013","article-title":"Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography","volume":"22","author":"Zoghbi","year":"2009","journal-title":"J Am Soc Echocardiogr"},{"key":"2024052309210865700_bib19","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jcmg.2017.12.015","article-title":"Prognostic value of right ventricular dysfunction on clinical outcomes after transcatheter aortic valve replacement","volume":"12","author":"Asami","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024052309210865700_bib20","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1093\/eurheartj\/ehx381","article-title":"Staging classification of aortic stenosis based on the extent of cardiac damage","volume":"38","author":"G\u00e9n\u00e9reux","year":"2017","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib21","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/j.jcin.2020.04.015","article-title":"Impact of left ventricular outflow tract calcification on procedural outcomes after transcatheter aortic valve replacement","volume":"13","author":"Okuno","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib22","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jcin.2021.11.013","article-title":"Validation of the VARC-3 technical success definition in patients undergoing TAVR","volume":"15","author":"Tomii","year":"2022","journal-title":"JACC Cardiovasc Interv"},{"key":"2024052309210865700_bib23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/eurheartj\/ehq406","article-title":"Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium","volume":"32","author":"Leon","year":"2011","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib24","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1093\/eurheartj\/ehs255","article-title":"Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document","volume":"33","author":"Kappetein","year":"2012","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib25","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1093\/eurheartj\/ehaa799","article-title":"Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research","volume":"42","author":"G\u00e9n\u00e9reux","year":"2021","journal-title":"Eur Heart J"},{"key":"2024052309210865700_bib26","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1080\/00031305.1998.10480559","article-title":"Violin plots: a box plot-density trace synergism","volume":"52","author":"Hintze","year":"1998","journal-title":"Am Stat"},{"key":"2024052309210865700_bib27","doi-asserted-by":"crossref","first-page":"e0238835","DOI":"10.1371\/journal.pone.0238835","article-title":"Analyzing the fine structure of distributions","volume":"15","author":"Thrun","year":"2020","journal-title":"PLoS One"},{"key":"2024052309210865700_bib28","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/sim.4780080204","article-title":"Factorial designs in clinical trials: the effects of non-compliance and subadditivity","volume":"8","author":"Brittain","year":"1989","journal-title":"Stat Med"},{"key":"2024052309210865700_bib29","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1136\/heartjnl-2014-307067","article-title":"Evolution and prognostic impact of low flow after transcatheter aortic valve replacement","volume":"101","author":"Le Ven","year":"2015","journal-title":"Heart"},{"key":"2024052309210865700_bib30","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1001\/jamacardio.2016.0759","article-title":"Evaluation of flow after transcatheter aortic valve replacement in patients with low-flow aortic stenosis: a secondary analysis of the PARTNER randomized clinical trial","volume":"1","author":"Anjan","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2024052309210865700_bib31","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1016\/j.jacc.2020.03.042","article-title":"Regression of left ventricular mass after transcatheter aortic valve replacement: the PARTNER trials and registries","volume":"75","author":"Chau","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2024052309210865700_bib32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1161\/CIRCINTERVENTIONS.112.000124","article-title":"Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation","volume":"6","author":"Stortecky","year":"2013","journal-title":"Circ Cardiovasc Interv"},{"key":"2024052309210865700_bib33","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1136\/heartjnl-2019-314996","article-title":"Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis","volume":"106","author":"Zhang","year":"2020","journal-title":"Heart"},{"key":"2024052309210865700_bib34","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jcmg.2012.10.015","article-title":"Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF","volume":"6","author":"Clavel","year":"2013","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcad045\/51025835\/qcad045.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/10\/3\/246\/57837310\/qcad045.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/10\/3\/246\/57837310\/qcad045.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T09:21:34Z","timestamp":1716456094000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/10\/3\/246\/7231078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,7,25]]},"published-print":{"date-parts":[[2024,5,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcad045","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4]]},"published":{"date-parts":[[2023,7,25]]}}}