Department of Cardiology, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark.
Am Heart J. 2009 Dec;158(6):983-8. doi: 10.1016/j.ahj.2009.09.013.
Restrictive diastolic filling pattern is associated with increased mortality in patients with myocardial infarction and heart failure. Most studies have excluded patients with atrial fibrillation. The aim of the present study was to assess the prognostic value of a restrictive filling pattern in patients with atrial fibrillation.
Doppler echocardiography including pulsed wave Doppler assessment of transmitral flow was performed in 880 patients with a clinical diagnosis of heart failure on hospital admission. Filling was considered restrictive when the mitral deceleration time <or=140 milliseconds.
On admission, 337 (39%) of the patients had atrial fibrillation. Among patients in atrial fibrillation, 170 (50%) had a restrictive filling; and in patients in sinus rhythm, 256 (47%) had restrictive filling (P = .34). During follow-up of median 6.7 years (range 5.3-7.8), 564 patients died (64%). Mortality was significantly higher in patients with a restrictive filling pattern irrespective of atrial fibrillation or sinus rhythm (P < .001). In a multivariable model only including patients in atrial fibrillation, a restrictive filling pattern remained a significant predictor of all-cause mortality (hazard ratio 1.79, 95% CI 1.24-2.58, P =.002).
In a heterogeneous population hospitalized for symptomatic heart failure, a restrictive transmitral filling pattern during hospitalization is an ominous prognostic sign also in patients presenting with atrial fibrillation.
限制型充盈模式与心肌梗死和心力衰竭患者的死亡率增加相关。大多数研究都排除了心房颤动患者。本研究旨在评估心房颤动患者限制型充盈模式的预后价值。
在因心力衰竭入院的 880 例患者中进行了多普勒超声心动图检查，包括对二尖瓣前向血流的脉冲波多普勒评估。当二尖瓣减速时间<或=140 毫秒时，认为充盈受限。
入院时，337 例（39%）患者存在心房颤动。在心房颤动患者中，170 例（50%）存在限制型充盈；而在窦性心律患者中，256 例（47%）存在限制型充盈（P =.34）。在中位随访 6.7 年（范围 5.3-7.8 年）期间，564 例患者死亡（64%）。无论是否存在心房颤动或窦性心律，限制型充盈模式患者的死亡率均显著更高（P <.001）。在仅包括心房颤动患者的多变量模型中，限制型充盈模式仍然是全因死亡率的显著预测因素（风险比 1.79，95%CI 1.24-2.58，P =.002）。
在因有症状心力衰竭住院的异质人群中，住院期间出现限制型二尖瓣充盈模式也是心房颤动患者预后不良的一个凶险征象。
