Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study.
Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study.
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DOI：
10.1161/circulationaha.113.001475
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发表时间：
2013-09-03
期刊：
影响因子：
37.8
通讯作者：
Redfield MM
中科院分区：
文献类型：
--
作者：
Zakeri R;Chamberlain AM;Roger VL;Redfield MM
在心力衰竭(HF)和射血分数保留(HFpEF)的患者中，房颤(AF)可能在HFpEF诊断之前、同时发生或发展。我们试图定义房颤和HFpEF之间的时间关系，确定与房颤相关的因素，并确定在HFpEF中房颤的流行和发生对预后的影响。自1983年至2010年，对939名奥姆斯特县MN居民(年龄77±12岁，61%女性)新诊断的高血压性肺功能(EF≥)进行了评估。基线心律分类包括：既往房颤(确诊前3个月)、并发房颤(±3个月)或窦性心律(SR)。发生房颤事件(在HFpEF诊断后3个月)和全因死亡被确认至2012年2月。与SR相比，在HFpEF诊断时，既往房颤(29%)和并发房颤(23%)与年龄大、BNP高和左房容量指数大相关。在确诊时在SR中的HFpEF患者中，32%的患者在3.7(1.5-6.7)年(每1000人年发生69次事件)的中位(IQR)随访期内发生房颤。年龄和舒张期功能障碍与房颤的发生呈正相关，而他汀类药物的使用与房颤的发生呈负相关。以无房颤为参照物，既往或并发房颤(合并的HR1.3，95%CI1.0-1.6，p=0.03)和事件房颤(HR2.1，95%CI1.4-3.0，p<；0.001)与死亡调整相关协变量独立相关。在自然病史的某个时间点，三分之二的HFpEF患者会发生房颤，预后很差。需要进一步的研究来确定对房颤的干预是否可以改善预后，或者他汀类药物的使用是否可以预防HFpEF中的房颤。
In patients with heart failure (HF) and preserved ejection fraction (HFpEF), atrial fibrillation (AF) may predate, concur with, or develop after HFpEF diagnosis. We sought to define the temporal relationship between AF and HFpEF, identify factors associated with AF, and determine the prognostic impact of prevalent and incident AF in HFpEF. From 1983 to 2010, 939 Olmsted County, MN residents (age 77±12years, 61% female) newly diagnosed with HFpEF (EF≥0.50) were evaluated. Baseline rhythm classification included: prior AF (>3 months before HFpEF diagnosis), concurrent AF (±3months), or sinus rhythm (SR). Incident AF (>3months after HFpEF diagnosis) and all-cause mortality were ascertained through February 2012. Prior (29%) and concurrent AF (23%) were associated with older age, higher BNP, and larger left atrial volume index at HFpEF diagnosis compared to SR. Of HFpEF patients in SR at diagnosis, 32% developed AF over a median (IQR) follow-up of 3.7(1.5–6.7) years (69 events per 1000 person-years). Age and diastolic dysfunction were positively, while statin use was inversely associated with incident AF. Using no AF as the referent, prior or concurrent AF (combined HR 1.3, 95%CI 1.0–1.6, p=0.03) and incident AF, modeled as a time-dependent covariate, (HR 2.1, 95%CI 1.4–3.0, p<0.001), were independently associated with death adjusting for pertinent covariates. AF occurs in two-thirds of HFpEF patients at some point in the natural history and confers a poor prognosis. Further study is required to determine whether intervention for AF may improve outcomes or if statin use can prevent AF in HFpEF.