Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM
Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM
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DOI：
10.1016/j.hrthm.2004.08.008
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发表时间：
2004-12-01
期刊：
影响因子：
5.5
通讯作者：
Ray, WA
中科院分区：
文献类型：
--
作者：
Murray, KT;Rottman, JN;Ray, WA
目的 我们研究了抑制内源性血管紧张素 II 信号传导是否可以降低参加心房颤动心律管理随访调查 (AFFIRM) 研究的患者的心房颤动 (AF) 复发率。 背景 结构和电重塑有助于 AF。先前的实验研究表明血管紧张素 II 信号通路参与了这一过程，最近的临床证据支持抑制血管紧张素 II 活性的有益作用。 方法使用 AFFIRM 数据库，我们回顾性地确定了一组随机分配到心律控制组的窦性心律患者。确定血管紧张素 II 受体阻滞剂或血管紧张素转换酶抑制剂 (ANGI) 的暴露情况，并比较 ANGI 使用者和非使用者之间 AF 首次复发的时间。 结果 研究队列包括 732 名在最初 2 个月随访期间未服用 ANGI 的患者和 421 名在此期间服用 ANGI 的患者。与未服用 ANGI 的患者相比，ANGI 组的患者更有可能患有高血压、糖尿病、冠状动脉疾病和充血性心力衰竭。 ANGI 治疗组的房颤复发风险与未服用药物的患者观察到的风险没有差异（风险比 [HR] = 0.91，95% 置信区间 [CI] = 0.77-1.09）。然而，在充血性心力衰竭或左心室功能受损的患者中，使用 ANGI 与 AF 复发风险较低相关。 结论 本分析提供的证据表明，使用 ANGI 可能对某些 AF 患者亚组有益，并强调需要进行随机临床试验来更全面地定义血管紧张素 II 抑制在治疗 AF 中的作用。 (C) 2004 年心律协会。版权所有。
OBJECTIVES We investigated whether inhibition of endogenous angiotensin II signaling reduces the recurrence rate of atrial fibrillation (AF) in patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.BACKGROUND Structural and electrical remodeling contribute to AF. Previous experimental studies have implicated the angiotensin II signaling pathway in this process, and recent clinical evidence supports a beneficial effect of inhibiting angiotensin II activity.METHODS Using the AFFIRM database, we retrospectively identified a cohort of patients randomized to the rhythm-control arm who were in sinus rhythm. Exposure to angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (ANGI) was determined, and the time to first recurrence of AF was compared between ANGI users and nonusers.RESULTS The study cohort included 732 patients not taking ANGI through the initial 2-month follow-up and 421 patients taking ANGI during this time. Patients in the ANGI group more likely had hypertension, diabetes, coronary artery disease, and congestive heart failure compared to patients not taking ANGI. Risk of AF recurrence in the ANGI treatment group did not differ from the risk observed in patients not taking the drugs (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.77-1.09). However, in patients with congestive heart failure or impaired left ventricular function, ANGI use was associated with a lower risk of AF recurrence.CONCLUSIONS This analysis provides evidence that ANGI use may be beneficial in some patient subgroups with AF and underscores the need for randomized clinical trials defining more fully the role of angiotensin II inhibition in treating AF. (C) 2004 Heart Rhythm Society. All rights reserved.