Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
J Am Coll Cardiol. 2010 Feb 23;55(8):725-31. doi: 10.1016/j.jacc.2009.11.040.
We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population.
Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF.
We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified.
Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events.
A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future.
我们研究了心房颤动（AF）进展的临床相关性，并评估了在大样本人群中显示 AF 进展的患者的预后。
阵发性 AF 向更持续形式的进展较为常见。然而，并非所有患者都会进展为持续性 AF。
我们纳入了 1219 例阵发性 AF 患者，这些患者参加了 Euro Heart Survey on AF 研究，并在随访时已知节律状态。确定了在随访 1 年后发生 AF 进展的患者。
178 例（15%）患者发生了 AF 进展。多变量分析显示，心力衰竭、年龄、既往短暂性脑缺血发作或中风、慢性阻塞性肺疾病和高血压是 AF 进展的唯一独立预测因素。使用回归系数作为基准，我们计算了 HATCH 评分。HATCH 评分>5 的患者中近 50%进展为持续性 AF，而 HATCH 评分 0 的患者中仅有 6%进展为持续性 AF。在随访期间，AF 进展的患者更经常住院，且发生更多主要不良心血管事件。
相当数量的患者在 1 年内进展为持续性 AF。与未发生 AF 进展的患者相比，这些患者的住院和主要不良心血管事件的临床结局更差。已知可导致心房结构重塑的因素（年龄和潜在心脏病）是 AF 进展的独立预测因素。HATCH 评分可帮助识别近期可能进展为持续性 AF 的患者。
