Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry
Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry
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DOI：
10.1093/eurheartj/ehy626
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发表时间：
2018-12-21
影响因子：
39.3
通讯作者：
Amir, Offer
中科院分区：
文献类型：
--
作者：
Zafrir, Barak;Lund, Lars H.;Amir, Offer
目的探讨乳腺癌的特征及其对远期预后的影响与窦性心律（SR）相比，急性和慢性心力衰竭（HF）之间的房颤（AF）（长达1.2年），（HFrEF < 40%），中等（HFmrEF 40-49%），并保存（HFpEF >= 50%）射血分数（EF）。对欧洲心脏病学会的HF长期登记进行了分析。共入组了14964例HF患者（年龄66 ± 13岁，67%为男性; 53%为HFrEF，21%为HFmrEF，26%为HFpEF）。HFrEF、HFmrEF和HFpEF的AF患病率分别为27%、29%和39%。房颤与年龄较大、功能能力较低和HF体征升高相关。在每种EF亚型中，AF患者的粗死亡率和HF住院率均高于SR患者。多变量校正后，HF住院的AF风险比为：1.036（95% CI 0.888-1.208，P = 0.652），HFrEF，1.430（95% CI 1.087-1.882，P = 0.011），HFmrEF和1.487（95% CI 1.195-1.851，P < 0.001）;对于合并的全因死亡或HF住院：分别为0.957（95%CI 0.843-1.087，P = 0.502）、1.302（95%CI 1.055-1.608，P = 0.014）和1.365（95%CI 1.152-1.619，P < 0.001）。在HFrEF患者中，AF与急性或慢性HF.Conclusions AF的患病率随着EF的增加而增加，但与HFpEF和HFmrEF患者的心血管结局恶化相关，但与HFrEF患者无关。
Aim To investigate the characteristics long-term prognostic implications (up to similar to 1.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF >= 50%) ejection fraction (EF).Methods and results Data from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 13 years, 67% male; 53% HFrEF, 21% HFmrEF, 26% HFpEF) were enrolled. The prevalence of AF was 27% in HFrEF, 29% in HFmrEF, and 39% in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95% Cl 0.888-1.208, P = 0.652) in HFrEF, 1.430 (95% Cl 1.087-1.882, P = 0.011) in HFmrEF, and 1.487 (95% Cl 1.195-1.851, P < 0.001) in HFpEF; and for combined all-cause death or HF hospitalizations: 0.957 (95% Cl 0.843-1.087, P = 0.502), 1.302 (95% Cl 1.055-1.608, P = 0.014), and 1.365 (95% Cl 1.152-1.619, P < 0.001), respectively. In patients with HFrEF, AF was not associated with worse outcomes in those presenting with either an acute or a chronic presentation of HF.Conclusions The prevalence of AF increases with increasing EF but is association with worse cardiovascular outcome remained significant in patients with HFpEF and HFmrEF, but not in those with HFrEF.