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Philippe Pibarot

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Open access Aug 2026

Impact of Atrial Fibrillation on Long-Term Outcomes of Aortic Stenosis.

BACKGROUND Atrial fibrillation (AF) is common in patients with aortic stenosis (AS), but its independent long-term prognostic impact on outcomes remains uncertain. We examined the association between AF and mortality risk across the full spectrum of AS. METHOD In this retrospective cohort study, we included 1592 patients with at least mild AS and preserved left ventricular ejection fraction (≥50%). Patients were stratified by AF status. Primary and secondary end points were all-cause and cardiovascular mortality, respectively. RESULTS Of 1592 patients, including the full spectrum of AS severity, 254 (16%) had AF. AF was more prevalent in patients with severe paradoxical low-flow low-gradient (36%) compared with severe normal-flow (12%), severe high-gradient (10%), and mild-to-moderate (16%) AS (P<0.001). During a median follow-up of 7.2 (interquartile range, 3.6-11.0) years, 885 deaths occurred (49% cardiovascular-related). AF was associated with an increased risk of all-cause and cardiovascular mortality (both P<0.001). In multivariable Cox models, AF independently predicted a higher risk of all-cause (hazard ratio [HR], 1.78 [95% CI, 1.34-2.36], P<0.001) and cardiovascular (HR, 1.77 [95% CI, 1.20-2.62], P=0.004) mortality. The prognostic impact was greatest for permanent/persistent AF (HR, 2.04) and significant for paroxysmal AF (HR, 1.69). The association of AF with outcomes remained consistent across various subgroups, including AS flow-gradient patterns (all interaction P>0.05). CONCLUSION In this large cohort with AS, AF was independently associated with an increased risk of both all-cause and cardiovascular mortality, regardless of treatment strategy or AS flow-gradient pattern. AF should be integrated into risk stratification algorithms in AS, beyond parameters of AS severity.

Thomas Reed-Métayer, Pier-Anthony Bouchard, Sébastien Hecht et al. · 0 citations
Review Jul 2026

The role of selective multidetector computed tomography after transcatheter aortic valve implantation.

Transcatheter aortic valve implantation is increasingly performed in younger and lower-risk patients, shifting attention toward long-term prosthetic valve durability. While transthoracic echocardiography remains the cornerstone of follow-up, it primarily reflects global hemodynamics and may not detect early structural or geometric abnormalities after implantation. Hypoattenuated leaflet thickening and reduced leaflet motion, collectively referred to as subclinical leaflet thrombosis, represent dynamic phenomena that may precede overt valve dysfunction. Growing evidence suggests that prosthesis geometry, including under-expansion, ellipticity, commissural misalignment, canting and implantation depth, may alter neo-sinus flow and promote thrombotic substrate formation. Multidetector computed tomography enables integrated assessment of leaflet morphology, perivalvular thrombus, and prosthetic geometry, providing insights into the mechanical determinants of thrombosis. In this State-of-the-Art review, we examine the role of multimodality imaging in identifying thrombogenic valve phenotypes and propose a pragmatic imaging framework integrating echocardiography with selective multidetector computed tomography to support individualized post-TAVI surveillance and management.

M. Moscarelli, Philippe Pibarot, N. V. vanMieghem et al. · 0 citations

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