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Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm

  • Hyun-Jin Kim
  • Goo-Yeong Cho
  • Yong-Jin Kim
  • Hyung-Kwan Kim
  • Seung-Pyo Lee
  • Hack-Lyoung Kim
  • Jin Joo Park
  • Yeonyee E. Yoon
  • Joo-Hee Zo
  • Dae-Won Sohn
Original Paper

Abstract

This study evaluated the predictors of atrial fibrillation (AF) and adverse clinical events in patients with rheumatic mitral stenosis (RMS) in sinus rhythm. The patients who diagnosed with RMS in sinus rhythm were evaluated retrospectively between March 2003 and June 2013. The primary outcome was the development of new-onset AF with annual event rates and the secondary outcome was the incidence of clinical events including development of new-onset AF, systemic embolism and all-cause death during follow-up. Among 293 patients, AF developed in 60 (20.5 %) patients with average annual event rate of 3.5 %/year during mean follow-up period of 68.2 ± 36.6 months (median 72 months). All cause death or systemic embolism occurred in 7.2 % (21 patients; all cause death 9, embolism 12) with an average annual event rate of 2.1 %. In the multivariate analysis, large left atrium (LA) dimension and severe mitral stenosis (≤1.5 cm2) were independent predictors of AF development [HR 1.06, 95 % CI: 1.02–1.10; P = 0.001, HR 1.97, 95 % CI: 1.06–4.14; P = 0.032] after adjustment for confounding factors. Patients with enlarged LA (≥47 mm) had an average annual AF development rate of 6.0 %/year. In patients with RMS in sinus rhythm, annual AF development rate was 3.5 %/year and increased according to LA size and mitral stenosis (MS) severity. Because of very high risk embolism, RMS with enlarged LA dimension need focused follow up for early detection of AF development and clinical events.

Keywords

Mitral valve stenosis Sinus rhythm Embolism Atrial fibrillation 

Abbreviations

AF

Atrial fibrillation

CI

Confidence interval

CT

Computed tomographic

ECG

Electrocardiography

EROA

Effective regurgitation orifice area

GFC

Global fibrinolytic capacity

GFR

Glomerular filtration rate

HR

Hazard ratio

LA

Left atrium

MR

Mitral regurgitation

MRI

Magnetic resonance imaging

MS

Mitral stenosis

MVA

Mitral valve area

PISA

Proximal isovelocity surface area

RMS

Rheumatic mitral stenosis

TTE

Transthoracic echocardiography

Notes

Conflict of interest

None declared.

Supplementary material

10554_2015_613_MOESM1_ESM.pdf (43 kb)
Supplementary material 1 (PDF 42 kb)

References

  1. 1.
    Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, American College of Cardiology/American Heart Association Task Force on Practice G (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(13):e1–e142CrossRefPubMedGoogle Scholar
  2. 2.
    Carabello BA (2005) Modern management of mitral stenosis. Circulation 112(3):432–437CrossRefPubMedGoogle Scholar
  3. 3.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. doi: 10.1016/j.jacc.2014.02.536 Google Scholar
  4. 4.
    Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496CrossRefGoogle Scholar
  5. 5.
    Chiang CW, Lo SK, Ko YS, Cheng NJ, Lin PJ, Chang CH (1998) Predictors of systemic embolism in patients with mitral stenosis. A prospective study. Ann Intern Med 128(11):885–889CrossRefPubMedGoogle Scholar
  6. 6.
    Manjunath CN, Srinivasa KH, Panneerselvam A, Prabhavathi B, Ravindranath KS, Rangan K, Dhanalakshmi C (2011) Incidence and predictors of left atrial thrombus in patients with rheumatic mitral stenosis and sinus rhythm: a transesophageal echocardiographic study. Echocardiography 28(4):457–460CrossRefPubMedGoogle Scholar
  7. 7.
    Diker E, Aydogdu S, Ozdemir M, Kural T, Polat K, Cehreli S, Erdogan A, Goksel S (1996) Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease. Am J Cardiol 77(1):96–98CrossRefPubMedGoogle Scholar
  8. 8.
    Wunderlich NC, Beigel R, Siegel RJ (2013) Management of mitral stenosis using 2D and 3D echo-Doppler imaging. J Am Coll Cardiol Imaging 6(11):1191–1205CrossRefGoogle Scholar
  9. 9.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: eAE/ASE recommendations for clinical practice. Eur J Echocardiogr 10(1):1–25CrossRefPubMedGoogle Scholar
  10. 10.
    Chiampan A, Nahum J, Leye M, Oziel J, Cueff C, Brochet E, Iung B, Rossi A, Vahanian A, Messika-Zeitoun D (2012) Determinants of regurgitant volume in mitral regurgitation: contrasting effect of similar effective regurgitant orifice area in functional and organic mitral regurgitation. Eur Heart J Cardiovasc Imaging 13(4):324–329CrossRefPubMedGoogle Scholar
  11. 11.
    Stoddard MF, Dawkins PR, Prince CR, Ammash NM (1995) Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study. J Am Coll Cardiol 25(2):452–459CrossRefPubMedGoogle Scholar
  12. 12.
    Bakshi R (2000) Diffusion-weighted MRI as an evolving standard of care in acute stroke. Neurology 55(10):1595CrossRefPubMedGoogle Scholar
  13. 13.
    Selcuk MT, Selcuk H, Maden O, Temizhan A, Aksu T, Dogan M, Sasmaz A (2007) Relationship between inflammation and atrial fibrillation in patients with isolated rheumatic mitral stenosis. J Heart Valve Dis 16(5):468–474PubMedGoogle Scholar
  14. 14.
    Perez-Gomez F, Salvador A, Zumalde J, Iriarte JA, Berjon J, Alegria E, Almeria C, Bover R, Herrera D, Fernandez C (2006) Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial. Eur Heart J 27(8):960–967CrossRefPubMedGoogle Scholar
  15. 15.
    Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E (1970) Systemic embolism in mitral valve disease. Br Heart J 32(1):26–34CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Golbasi Z, Cicek D, Canbay A, Ucar O, Bayol H, Aydogdu S (2002) Left atrial appendage function in patients with mitral stenosis in sinus rhythm. Eur J Echocardiogr 3(1):39–43CrossRefPubMedGoogle Scholar
  17. 17.
    Li YH, Hwang JJ, Lin JL, Tseng YZ, Lien WP (1996) Importance of left atrial appendage function as a risk factor for systemic thromboembolism in patients with rheumatic mitral valve disease. Am J Cardiol 78(7):844–847PubMedGoogle Scholar
  18. 18.
    Atalar E, Ozmen F, Haznedaroglu I, Ozer N, Aksoyek S, Ovunc K, Nazli N, Kirazli S, Kes S (2002) Impaired fibrinolytic capacity in rheumatic mitral stenosis with or without atrial fibrillation and nonrheumatic atrial fibrillation. Int J Hematol 76(2):192–195CrossRefPubMedGoogle Scholar
  19. 19.
    Yavuz B, Ertugrul DT, Yalcin AA, Kucukazman M, Ata N, Dal K (2009) Increased mean platelet volume in rheumatic mitral stenosis: a possible factor for thromboembolic events. J Cardiol 53(2):204–207CrossRefPubMedGoogle Scholar
  20. 20.
    Kaymaz C, Ozdemir N, Erentug V, Sismanoglu M, Yakut C, Ozkan M (2003) Location, size, and morphologic characteristics of left atrial thrombi as assessed by transesophageal echocardiography in relation to systemic embolism in patients with rheumatic mitral valve disease. Am J Cardiol 91(6):765–769CrossRefPubMedGoogle Scholar
  21. 21.
    Falgá C, Capdevila JA, Soler S, Rabuñal R, Sánchez Muñoz-Torrero JF, Gallego P, Monreal M, Investigators R (2007) Clinical outcome of patients with venous thromboembolism and renal insufficiency. Findings from the RIETE registry. Thromb Haemost 98(4):771–776PubMedGoogle Scholar
  22. 22.
    Apostolakis S, Guo Y, Lane DA, Buller H, Lip GY (2013) Renal function and outcomes in anticoagulated patients with non-valvular atrial fibrillation: the AMADEUS trial. Eur Heart J 34(46):3572–3579CrossRefPubMedGoogle Scholar
  23. 23.
    Wanishsawad C, Weathers LB, Puavilai W (1995) Mitral regurgitation and left atrial thrombus in rheumatic mitral valve disease. A clinicopathologic study. Chest 108(3):677–681CrossRefPubMedGoogle Scholar
  24. 24.
    Nunes MC, Handschumacher MD, Levine RA, Barbosa MM, Carvalho VT, Esteves WA, Zeng X, Guerrero JL, Zheng H, Tan TC, Hung J (2014) Role of LA shape in predicting embolic cerebrovascular events in mitral stenosis: mechanistic insights from 3D echocardiography. J Am Coll Cardiol Imaging 7(5):453–461CrossRefGoogle Scholar
  25. 25.
    Keenan NG, Cueff C, Cimadevilla C, Brochet E, Lepage L, Detaint D, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D (2010) Usefulness of left atrial volume versus diameter to assess thromboembolic risk in mitral stenosis. Am J Cardiol 106(8):1152–1156CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Hyun-Jin Kim
    • 1
    • 3
  • Goo-Yeong Cho
    • 1
    • 2
  • Yong-Jin Kim
    • 1
    • 3
  • Hyung-Kwan Kim
    • 1
    • 3
  • Seung-Pyo Lee
    • 1
    • 3
  • Hack-Lyoung Kim
    • 1
    • 4
  • Jin Joo Park
    • 1
    • 2
  • Yeonyee E. Yoon
    • 1
    • 2
  • Joo-Hee Zo
    • 1
    • 4
  • Dae-Won Sohn
    • 1
    • 3
  1. 1.Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Cardiovascular CenterSeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
  4. 4.Cardiovascular CenterSeoul National University Boramae Medical CenterSeoulSouth Korea

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