Aortic Stenosis and Autonomic Dysfunction: Co-Conspirators in Syncope

Orthostatic hypotension is associated with new-onset atrial fibrillation: Systemic review and meta-analysis

Introduction

Orthostatic hypotension (OH) is common among elderly patients. Its presence may herald severe underlying comorbidities and be associated with a higher risk of mortality. Interestingly, recent studies suggest that OH is associated with new-onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been performed. We assessed the association between AF and OH through a systematic review of the literature and a meta-analysis.

Methods

We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2018. Published prospective or retrospective cohort studies that compared new-onset AF between male patients with and without OH were included. Data from each study were combined using the random-effects, generic inverse-variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.

Results

Four studies from October 2010 to March 2018 were included in the meta-analysis involving 76,963 subjects (of which 3318 were diagnosed with OH). The presence of OH was associated with new-onset AF (pooled risk ratio 1.48; 95% confidence interval [1.21, 1.81], p?< 0.001; I2 = 69.4%). In hypertensive patients, analysis revealed an association between OH and the occurrence of new-onset AF (OR 1.46; 95% CI [1.27, 1.68], p < 0.001 with I2 = 0).

Conclusions

OH was associated with new-onset AF up to 1.5-fold compared with those subjects without OH. The interplay between OH and AF is likely bidirectional.

Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: the SEAS study

BACKGROUND

An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown.

METHODS

RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se.

RESULTS

1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction).

CONCLUSIONS

RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).

Validity of an instrument to measure the impact of valve heart disease on the patient's daily life

AIM

This study was to verify the psychometric properties of the Heart Valve Disease Impact on daily life, an instrument for measuring the impact of illness in the daily life of the heart valve disease patient, related to its construct validity, criterion-related validity and reliability.

METHODS

One hundred and twenty heart valve disease outpatients were enrolled. Data were submitted to descriptive analysis, factor analysis, Pearson's correlation coefficient and Cronbach's alpha coefficient.

RESULTS

The factor analysis generated four factors that explained 58% of the variance in response to the Heart Valve Disease Impact on daily life. Weak to moderate correlation was measured between the Heart Valve Disease Impact on daily life total score and two of its factors and the General Measure of Impact of illness, indicating criterion-related validity. A Cronbach's alpha of 0.74 was measured.

CONCLUSION

The results of the current study confirm both the construct and criterion validity and the internal consistency of the Heart Valve Disease Impact on daily life. Future studies are necessary to confirm its reliability and provide a better understanding of the meaning of the Heart Valve Disease Impact on daily life dimensions, as well as to evaluate its response to health interventions.

RELEVANCE TO CLINICAL PRACTICE

The Heart Valve Disease Impact on daily life could be a useful instrument to measure the impact of heart valve disease and to evaluate the response to health interventions.