心率和节律控制对持续性心房颤动患者左心室功能及心脏大小的影响：持续性心房颤动心率控制与电复律（RACE）研究结果

Effect of rate and rhythm control on left ventricular function and cardiac dimensions in patients with persistent atrial fibrillation: results from the RAte Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study.

作者信息

Hagens Vincent E, Van Veldhuisen Dirk J, Kamp Otto, Rienstra Michiel, Bosker Hans A, Veeger Nic J G M, Tijssen Jan G P, Crijns Harry J G M, Van Gelder Isabelle C

机构信息

Department of Cardiology, University Hospital, Groningen, The Netherlands.

出版信息

Heart Rhythm. 2005 Jan;2(1):19-24. doi: 10.1016/j.hrthm.2004.09.028.

DOI:10.1016/j.hrthm.2004.09.028

PMID:15851259

Abstract

OBJECTIVES

The purpose of this study was to evaluate left ventricular function and atrial and ventricular diameters in patients with persistent atrial fibrillation (AF) treated with rate or rhythm control.

BACKGROUND

Restoration of sinus rhythm in patients with persistent AF may improve left ventricular function and reduce atrial dimensions. Adequate rate control in AF may preserve ventricular function.

METHODS

In 335 patients included in the RAte Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study, echocardiography was performed at baseline and 1- and 2-year follow-up. Echocardiography was compared between patients randomized to rate control (n = 160) and rhythm control (n = 175). In the rhythm control group, echocardiography was compared between patients with AF versus sinus rhythm at study end. Multivariate analysis was performed to determine parameters related to improvement of left ventricular function and increase of atrial diameters.

RESULTS

Fractional shortening improved significantly under rate and rhythm control (31 +/- 10% at baseline to 33 +/- 9% at 2 years, and from 30 +/- 10% to 34 +/- 9%; both P < .05, respectively). Under rate control, left and right atrial size increased significantly compared to baseline. Under rhythm control, only left atrial size increased. Multivariate analysis revealed that only sinus rhythm at study end was associated with an increase of fractional shortening. AF at study end, hypertension, and no use of angiotensin-converting enzyme inhibitors were independently associated with increase in atrial size.

CONCLUSIONS

Routine rate control prevents deterioration of left ventricular function. Maintenance of sinus rhythm is associated with improvement of left ventricular function and reduction of atrial sizes.

摘要

目的

本研究旨在评估接受心率控制或节律控制治疗的持续性心房颤动（AF）患者的左心室功能以及心房和心室直径。

背景

持续性AF患者恢复窦性心律可能改善左心室功能并减小心房大小。AF时充分的心率控制可维持心室功能。

方法

在纳入持续性心房颤动心率控制与电复律（RACE）研究的335例患者中，于基线以及1年和2年随访时进行超声心动图检查。对随机分为心率控制组（n = 160）和节律控制组（n = 175）的患者的超声心动图结果进行比较。在节律控制组中，对研究结束时处于AF和窦性心律的患者的超声心动图结果进行比较。进行多变量分析以确定与左心室功能改善和心房直径增加相关的参数。

结果

在心率控制和节律控制下，缩短分数均显著改善（基线时为31±10%，2年时为33±9%；以及从30±10%至34±9%；P值均＜0.05）。在心率控制下，与基线相比，左、右心房大小显著增加。在节律控制下，仅左心房大小增加。多变量分析显示，仅研究结束时的窦性心律与缩短分数增加相关。研究结束时的AF、高血压以及未使用血管紧张素转换酶抑制剂与心房大小增加独立相关。