McManus David D, Shaikh Amir Y, Abhishek Fnu, Vasan Ramachandran S
Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
Crit Pathw Cardiol. 2011 Mar;10(1):46-51. doi: 10.1097/HPC.0b013e31820e1a4b.
Heart failure (HF) and atrial fibrillation (AF) are 2 of the most common cardiovascular diseases encountered in clinical practice, and the prevalence of these diseases continues to grow worldwide with the aging of the global population. While recognizing that AF is a heterogeneous disorder, we submit that the parallels between AF and HF may arise because many cases of AF and HF result from the cumulative exposure of the atria and ventricles to a common set of systemic cardiovascular risk factors. Over time, exposure to risk factors promotes development of atrial and ventricular structural and functional abnormalities through activation of several biologic pathways in concert: upregulation of neurohormonal signaling cascades, release of inflammatory mediators, programmed cell death, and fibrosis. Cardiac structural remodeling occurs in concert with electrophysiologic remodeling, both of which contribute to atrial and ventricular rhythm disturbances, including AF. AF and HF, instead of representing distinct disease processes, often represent different endpoints along a disease continuum. By reviewing some of the mechanistic parallels between AF and HF, we hope to emphasize the connection between established cardiovascular risk factors, cardiac remodeling and AF, with a view to promote strategies for AF prevention.
心力衰竭（HF）和心房颤动（AF）是临床实践中最常见的两种心血管疾病，随着全球人口老龄化，这些疾病在全球的患病率持续上升。虽然认识到AF是一种异质性疾病，但我们认为AF和HF之间可能存在相似之处，因为许多AF和HF病例是由于心房和心室长期暴露于一组共同的全身性心血管危险因素所致。随着时间的推移，暴露于危险因素会通过协同激活多种生物学途径促进心房和心室结构及功能异常的发展：神经激素信号级联反应上调、炎症介质释放、程序性细胞死亡和纤维化。心脏结构重塑与电生理重塑同时发生，两者均导致心房和心室节律紊乱，包括AF。AF和HF并非代表不同的疾病过程，而往往代表疾病连续体上的不同终点。通过回顾AF和HF之间的一些机制相似之处，我们希望强调既定心血管危险因素、心脏重塑与AF之间的联系，以期促进AF预防策略。
