Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Am Coll Cardiol. 2011 Aug 23;58(9):942-9. doi: 10.1016/j.jacc.2011.04.030.
The aim of this study was to evaluate echocardiographic remodeling in permanent atrial fibrillation (AF) patients treated with either lenient or strict rate control.
It is unknown whether in permanent AF, lenient rate control is associated with more adverse cardiac remodeling than strict rate control.
Echocardiography was conducted at baseline and at follow-up in 517 patients included in the RACE II (RAte Control Efficacy in permanent atrial fibrillation II) trial. Echocardiographic parameters were compared between patients randomized to lenient rate control (n = 261) or strict rate control (n = 256).
Baseline echocardiographic parameters were comparable between patients randomized to lenient and strict rate control. Between baseline and follow-up, significant adverse atrial or ventricular remodeling was not observed in either group. There were also no significant differences in atrial and ventricular remodeling between patients who continuously had heart rates between 80 and 110 beats/min and patients who continuously had heart rates <80 beats/min during follow-up. Lenient rate control was not independently associated with changes in echocardiographic parameters: mean adjusted effect on left atrial size was 1.6 mm (p = 0.09) and 1.1 mm on left ventricular end-diastolic diameter (p = 0.23). Instead, female sex was independently associated with adverse remodeling: mean adjusted effect on left atrial size was 2.4 mm (p = 0.02) and 6.5 mm on left ventricular end-diastolic diameter (p < 0.0001).
Female sex, not lenient rate control, seemed to be associated with significant adverse cardiac remodeling in patients with permanent AF such as those enrolled in the RACE II study. (RAte Control Efficacy in Permanent Atrial Fibrillation [RACE II]; NCT00392613).
本研究旨在评估宽松和严格心率控制在永久性房颤（AF）患者中的心脏超声重构效果。
目前尚不清楚在永久性房颤中，宽松的心率控制是否比严格的心率控制更易导致不良的心脏重构。
在 RACE II（永久性房颤的心率控制效果 II）试验中，对 517 例患者进行了基线和随访时的超声心动图检查。比较了随机接受宽松心率控制（n = 261）或严格心率控制（n = 256）的患者之间的超声心动图参数。
随机接受宽松和严格心率控制的患者之间的基线超声心动图参数相当。在两组患者中，均未观察到心房或心室的明显不良重构。在随访期间，持续心率在 80-110 次/分和持续心率<80 次/分的患者之间，心房和心室重构也没有显著差异。宽松的心率控制与超声心动图参数的变化也没有独立相关：左心房大小的平均调整后效应为 1.6 毫米（p = 0.09），左心室舒张末期直径为 1.1 毫米（p = 0.23）。相反，女性与不良重构独立相关：左心房大小的平均调整后效应为 2.4 毫米（p = 0.02），左心室舒张末期直径为 6.5 毫米（p < 0.0001）。
在 RACE II 研究中，女性而不是宽松的心率控制似乎与永久性房颤患者的显著不良心脏重构相关。（永久性房颤的心率控制效果 [RACE II]；NCT00392613）。
