伴有和不伴有心房颤动的充血性心力衰竭——不同的患者群体？

Congestive heart failure with and without atrial fibrillation - different patient populations?

作者信息

Waldenhjort David, Mejhert Märit, Edner Magnus, Rosenqvist Mårten, Persson Hans

机构信息

Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.

出版信息

Scand Cardiovasc J. 2009 Jun;43(3):169-75. doi: 10.1080/14017430802535048.

DOI:10.1080/14017430802535048

PMID:19012076

Abstract

OBJECTIVES

Heart failure (HF) and atrial fibrillation (AF) are common comorbid conditions in hospitalised patients. AF may occur when left ventricular (LV) systolic function deteriorates. The aim was to compare HF patients with AF to patients in sinus rhythm (SR).

DESIGN

Echocardiography and a cardiopulmonary exercise test were performed in 67 patients with HF. Peak VO(2) was determined, as were LV-mass, enddiastolic, endsystolic volume indices (EDVI, ESVI), and ejection fraction (EF).

RESULTS

EF tended to be higher in AF compared to SR patients (39+/-10 vs. 31+/-10%), LV volume indices were smaller (ESVI:35+/-19 vs. 59+/-25 ml/m(2), p<0.0001, EDVI:56+/-24 vs. 83+/-29 ml/m(2), p<0.001). LV hypertrophy was prevalent (59% vs. 63%) and concentric hypertrophy tended to be more common with AF (50% vs. 21%). Peak VO(2) was similarly reduced in AF and SR (11.4+/-3.2 vs. 12.1+/-4.3 ml/kg*min).

CONCLUSIONS

HF patients with AF compared to SR tend to have smaller LV volumes, less compromised systolic function and more frequent LV concentric hypertrophy. Our study supports the concept that AF in HF indicates a different patient population rather than an effect of progressive LV systolic dysfunction.

摘要

目的

心力衰竭（HF）和心房颤动（AF）是住院患者常见的合并症。当左心室（LV）收缩功能恶化时可能会发生AF。目的是比较合并AF的HF患者与窦性心律（SR）患者。

设计

对67例HF患者进行了超声心动图和心肺运动试验。测定了峰值VO₂，以及左心室质量、舒张末期、收缩末期容积指数（EDVI、ESVI）和射血分数（EF）。

结果

与SR患者相比，AF患者的EF往往更高（39±10对31±10%），左心室容积指数更小（ESVI：35±19对59±25 ml/m²，p<0.0001，EDVI：56±24对83±29 ml/m²，p<0.001）。左心室肥厚很常见（59%对63%），AF患者同心性肥厚往往更常见（50%对21%）。AF和SR患者的峰值VO₂同样降低（11.4±3.2对12.1±4.3 ml/kg·min）。