Imaging for Risk Stratification in Atrial Fibrillation with Heart Failure.
Imaging for Risk Stratification in Atrial Fibrillation with Heart Failure.
复制标题
心力衰竭心房颤动风险分层的影像学。
DOI：
10.1016/j.ccl.2019.01.007
复制
发表时间：
2019
影响因子：
2.4
通讯作者：
Ranjan,Ravi
中科院分区：
文献类型：
--
作者：
Yamashita,Kennosuke;Ranjan,Ravi
房颤（AF）和心力衰竭（HF）与相似的风险因素相关，并且通常同时存在1，2。AF是射血分数正常的心力衰竭（HFpEF）或射血分数降低的心力衰竭（HFrEF）患者不良临床结局的潜在风险因素3。然而，在当前ACCF/AHA和ESC指南中，没有针对AF伴HF患者的具体建议（图1）4，5。房颤伴HF患者的主要推荐治疗目标仍然是预防血栓栓塞和缓解症状。根据指南，心率控制和节律控制被认为在发生AF的HF患者中具有同等作用，因为尚未证明节律控制治疗上级心率控制治疗6。因此，导管消融术仍被视为二线治疗。另一方面，对于AF后发生HF的患者，根据指南，应考虑积极的心律控制策略。这是因为在房颤伴快速心室反应的情况下新发HF的患者，可能的原因是心动过速诱导的心肌病。
Atrial Fibrillation (AF) and Heart Failure (HF) are associated with similar risk factors and are often present concomitantly1, 2. AF is a potent risk factor for adverse clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) 3. However, there are no specific recommendations for AF patients with HF in the current ACCF/AHA and ESC guidelines (Figure 1) 4, 5. The main recommended goals of therapy for AF patients with HF continues to focus on the prevention of thromboembolism and symptom relief. Per the guidelines, rate control and rhythm control are considered at par in patients with HF who develop AF, as rhythm control therapy has not been shown to be superior to a rate control therapy6. As a result, catheter ablation is still considered as a second line therapy. On the other hand, for patients who develop HF following AF, per the guidelines an aggressive rhythm control strategy should be considered. This is because patients who have newly developed HF in the presence of AF with rapid ventricular response the likely cause is tachycardia-induced cardiomyopathy.