Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction.
Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction.
复制标题
DOI：
10.1161/circulationaha.115.018614
复制
发表时间：
2016-02-02
期刊：
影响因子：
37.8
通讯作者：
Ho JE
中科院分区：
文献类型：
--
作者：
Santhanakrishnan R;Wang N;Larson MG;Magnani JW;McManus DD;Lubitz SA;Ellinor PT;Cheng S;Vasan RS;Lee DS;Wang TJ;Levy D;Benjamin EJ;Ho JE
心房颤动（AF）和心力衰竭（HF）经常共存，并共同导致不良预后。 AF 与 HF 亚型的关联尚未得到很好的描述。我们试图研究 AF 和 HF 与射血分数保留与射血分数降低（HFpEF 与 HFrEF）的时间关联的差异。我们对 1980 年至 2012 年间新发 AF 和/或 HF 的弗雷明汉心脏研究参与者进行了研究。在 1737 名新发 AF 患者中（平均年龄 75±12 岁，48% 为女性），超过三分之一 (37%) 患有 HF。相反，在 1166 名新发心力衰竭患者（平均年龄 79±11 岁，53% 女性）中，超过一半 (57%) 患有房颤。与 HFrEF（HR 1.32，95%CI 0.83-2.10）相比，流行 AF 与 HFpEF 事件的相关性更强（多变量调整风险比 [HR] 2.34，95% 置信区间 [CI] 1.48–3.70，无 AF 作为参照），HF 亚型之间存在差异趋势（P 值 0.06）。流行的心力衰竭与房颤发生相关（HR 2.18，95%CI 1.26-3.76，无心力衰竭作为参考）。与没有任何一种情况的人相比，同时存在 AF 和 HF 预示着更高的死亡风险，特别是对于新发 HFrEF 和普遍 AF 的个体（HR 2.72，95%CI 2.12–3.48），与新发 HFpEF 和普遍 AF 的个体（HR 1.83，95%CI 1.41–2.37，P 差异 0.02）相比。一半以上的心力衰竭患者发生房颤，三分之一以上的房颤患者发生心力衰竭。 AF 发生在 HFpEF 和 HFrEF 之前和之后，但在时间相关性和预后方面存在一些差异。未来的研究重点关注这些双重条件的潜在机制是有必要的。
Atrial fibrillation (AF) and heart failure (HF) frequently coexist and together confer an adverse prognosis. The association of AF with HF subtypes has not been well-described. We sought to examine differences in the temporal association of AF and HF with preserved versus reduced ejection fraction (HFpEF vs HFrEF). We studied Framingham Heart Study participants with new-onset AF and/or HF between 1980–2012. Among 1737 individuals with new AF, (mean-age 75±12, 48% women) more than one third (37%) had HF. Conversely among 1166 individuals with new HF (mean-age 79±11, 53% women), more than half (57%) had AF. Prevalent AF was more strongly associated with incident HFpEF (multivariable-adjusted hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.48–3.70, no AF as referent) vs HFrEF (HR 1.32, 95%CI 0.83–2.10), with a trend toward difference between HF subtypes (P for difference 0.06). Prevalent HF was associated with incident AF (HR 2.18, 95%CI 1.26–3.76, no HF as referent). The presence of both AF and HF portended greater mortality risk compared with those without either condition, particularly among individuals with new HFrEF and prevalent AF (HR 2.72, 95%CI 2.12–3.48) compared with new HFpEF and prevalent AF (HR 1.83, 95%CI 1.41–2.37, P for difference 0.02). AF occurs in more than half of individuals with HF, and HF in more than one third of individuals with AF. AF precedes and follows both HFpEF and HFrEF, with some differences in temporal association and prognosis. Future studies focused on underlying mechanisms of these dual conditions are warranted.