Atrial fibrilation in heart failure: Epidemiology, pathophysiology, and rationale for therapy
Atrial fibrilation in heart failure: Epidemiology, pathophysiology, and rationale for therapy
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DOI：
10.1016/s0002-9149(02)03373-8
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发表时间：
2003-03-20
影响因子：
2.8
通讯作者：
Stevenson, LW
中科院分区：
文献类型：
--
作者：
Maisel, WH;Stevenson, LW
心力衰竭（HF）影响美国近500万患者，是发病率和死亡率的主要原因。房颤（AF）与HF一样，影响数百万患者，并且随着年龄的增长，患病率显著增加。随着美国人口的老龄化，患有HF和AF的患者数量将继续增长。射血分数正常的心力衰竭在老年人群中特别常见。HF患者的AF患病率从纽约心脏协会（NYHA）功能I级HF患者的< 10%增加至NYHA功能IV级HF患者的约50%。HF和AF患者发生的病理生理变化复杂且尚未完全了解。神经激素激活、电生理参数和机械因素的改变共同创造了HF易患AF和AF加重HF的环境。其机制包括心房重构和心动过速诱导的肌病。HF中AF的发展似乎独立预测泵衰竭导致的死亡和总死亡率。虽然目前HF患者AF的治疗选择多种多样，但其对预后的影响仍不清楚，并且是正在进行的临床试验的主题。除了既往研究中占主导地位的射血分数低的人群外，还必须明确和计划专门针对AF、HF和射血分数正常的患者的治疗。(C)2003年，Excerpta Medica，Inc.
Heart failure (HF) affects almost 5 million patients in the United States and is a leading cause of morbidity and mortality. Atrial fibrillation (AF), like HF, affects millions of patients and markedly increases in prevalence with age. As the US population ages, the number of patients afflicted with HF and AF will continue to grow. HF with preserved ejection fraction is particularly common in e elderly population. The prevalence of AF in patients with HF increases from < 10% in those with New York Heart Association (NYHA) functional class I HF to approximately 50% in those with NYHA functional class IV HF. The pathophysiologic changes that occur in patients with HF and AF are complex and incompletely understood. Alterations in neurohormonal activation, electrophysiologic parameters, and mechanical factors conspire to create an environment in which HF predisposes to AF and AF exacerbates HF. Mechanisms include atrial remodeling and tachycardia-induced myopathy. The development of AF in HF appears to independently predict death resulting from pump failure and total mortality. Although the currently available therapeutic options for AF in patients with HF are varied, their effect on prognosis remains unknown and is the subject of ongoing clinical trials. It will be critical to define and plan therapies specifically for those patients with AF, HF, and preserved ejection fraction in addition to the population with low ejection fraction that has dominated previous investigations. (C) 2003 by Excerpta Medica, Inc.