Implications of QRS Prolongation in Patients With Atrial Fibrillation (from a Multicenter Outpatient Registry)
Implications of QRS Prolongation in Patients With Atrial Fibrillation (from a Multicenter Outpatient Registry)
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QRS 延长对心房颤动患者的影响（来自多中心门诊登记）
DOI：
10.1016/j.amjcard.2022.05.011
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Takatsuki Seiji
中科院分区：
文献类型：
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作者：
Miyama Hiroshi;Ikemura Nobuhiro;Kimura Takehiro;Katsumata Yoshinori;Fujisawa Taishi;Ueda Ikuko;Mitamura Hideo;Negishi Koji;Nagami Keiichi;Fukuda Keiichi;Kohsaka Shun;Takatsuki Seiji
需要确定进展为心力衰竭（HF）风险最高的房颤（AF）患者。我们研究了QRS持续时间是否可以对具有不良临床结局风险的AF患者进行分层，包括健康相关生活质量（HR-QoL）。我们分析了来自一项多中心基于登记的房颤患者队列研究的数据。根据登记时（基线）的QRS时限（窄：<120 ms;宽：≥120 ms）对患者进行分组。主要结局是2年随访期间全因死亡和HF住院的复合终点。此外，还比较了两组之间AF对生活质量总体总分的影响。在3，269例患者中，302例（9.2%）有宽QRS;这些患者更可能是年龄较大的男性，并且与窄QRS患者相比具有较高的CHA 2DS 2-VASc评分。宽QRS患者的复合结局发生率高于窄QRS患者（13.1% vs 4.9%，p <0.001）。校正后，宽QRS是主要结局的独立预测因子（校正后风险比1.58，95%置信区间1.09 - 2.29，p = 0.016），排除束分支传导阻滞或心脏植入式电子器械患者后，结果持续存在。关于HR-QoL结局，宽QRS患者与窄QRS患者相比，1年时AF对生活质量总体总分的影响改善的可能性较小（校正差异为-2.31，95%置信区间为-4.06至-0.57，p = 0.009）。QRS延长，即使是非特异性传导障碍，是AF患者不良结局和HR-QoL恶化的独立预测因子。
Patients with atrial fibrillation (AF) at the highest risk of progression to heart failure (HF) need to be identified. We investigated whether QRS duration can stratify patients with AF at risk for poor clinical outcomes, including health-related quality of life (HR-QoL). We analyzed data from a multicenter registry-based cohort study of patients with AF. Patients were grouped according to the QRS duration (narrow: <120 ms; wide: ≥120 ms) at registration (baseline). The primary outcome was a composite of all-cause death and HF hospitalizations during a 2-year follow-up. In addition, the AF effect on the quality-of-life overall summary score was compared between the groups. In 3,269 patients, 302 (9.2%) had a wide QRS; these patients were more likely to be older, male, and have higher CHA2DS2-VASc scores than those with a narrow QRS. The incidence of the composite outcome was higher in patients with a wide QRS than those with a narrow QRS (13.1% vs 4.9%, p <0.001). After adjustment, a wide QRS was an independent predictor of the primary outcome (adjusted hazard ratio 1.58, 95% confidence interval 1.09 to 2.29, p = 0.016), and the results persisted after the exclusion of patients with bundle branch block or cardiac implantable electronic devices. Regarding HR-QoL outcomes, patients with a wide QRS were less likely to improve AF effect on quality-of-life overall summary scores at 1 year than those with a narrow QRS (adjusted difference −2.31, 95% confidence interval −4.06 to −0.57, p = 0.009). QRS prolongation, even for a nonspecific conduction disturbance, was an independent predictor of adverse outcomes and worse HR-QoL in patients with AF.