Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure
Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure
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DOI：
10.1253/circj.69.823
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发表时间：
2005-07-01
影响因子：
3.3
通讯作者：
Izumi, T
中科院分区：
文献类型：
--
作者：
Koitabashi, T;Inomata, T;Izumi, T
背景 心房颤动 (AF) 在慢性心力衰竭 (CHF) 中的预后意义仍知之甚少。 方法和结果 对 1996 年至 2002 年住院的 427 名连续患者因 CHF 恶化而死亡和再住院的情况进行回顾性分析，与心律相关：窦性心律 (SR；n=239) 或 AF (n=188)。 AF 组根据除颤 AF 的干预组 (n=57) 或非干预组 (n=131) 进行分类。在 34-23 个月的随访期间，SR 组和 AF 组之间、干预组和非干预组之间的死亡率或发病率没有显着差异。然而，非干预组包括 28 名阵发性 AF (PAF) 患者（在住院期间自发转变为 SR）和 103 名慢性 AF (CAF) 患者。 PAF 患者因 CHF 加重而再次住院的情况显着高于 CAF 和 SR 患者（分别为 p=0.00005 和 0.002）。多变量 Cox 分析表明，PAF（而非 CAF）是再入院的预测因子（相对风险 2.30，p=0.004，95% 置信区间 1.30 至 4.05）。 结论 目前的数据表明，PAF 与心脏代偿失调同时发生可能是 CHF 预后的新预测因子。 CHF 的 AF 治疗策略应根据 AF 的表型进行讨论。
Background The prognostic significance of atrial fibrillation (AF) in chronic heart failure (CHF) remains poorly understood.Methods and Results Death and rehospitalizaion for CHF exacerbation for 427 consecutive patients hospitalized from 1996 to 2002 were retrospectively analyzed in relation to cardiac rhythm: sinus rhythm (SR; n=239) or AF (n=188). The AF group was classified according to an Intervention (n=57) or Non-Intervention (n=131) group for defibrillating AF. During the follow-up of 34 23 months, there was no significant difference of mortality or morbidity between the SR and AF groups, or between the Intervention and Non-Intervention groups, respectively. However, the Non-Intervention group consisted of 28 patients with paroxysmal AF (PAF), which spontaneously converted to SR during hospitalization, and 103 with chronic AF (CAF). The rehospitalization for CHF exacerbation was significantly higher in PAF than that in CAF and SR (p=0.00005 and 0.002, respectively). Multivariate Cox analysis demonstrated that, PAF, but not CAF, was a predictor of readmission (relative risk 2.30, p=0.004, 95% confidence interval 1.30 to 4.05).Conclusions The present data implied that PAF coincident with cardiac decompensation could be a new predictor of prognosis for CHF. The management strategies of AF in CHF should be discussed according to the phenotype of AF.