Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Heart. 2013 Jan;99(1):17-21. doi: 10.1136/heartjnl-2012-301980. Epub 2012 Sep 2.
The purpose of this study is to examine the risk of stroke in patients with heart failure with normal ejection fraction (HFNEF) and atrial fibrillation (AF).
Clinical and echocardiographic data in patients with non-valvular AF who were not on anticoagulation were retrospectively investigated. A total of 304 patients had AF without heart failure, and 102 patients were diagnosed as AF with HFNEF.
We compared the rate of ischaemic stroke, death and composite of these in the two groups.
Patients with AF and HFNEF were older than those with AF only (71.6 vs 64.0 years, p<0.001). Female sex, diabetes mellitus, hypertension, chronic kidney disease, angina, myocardial infarction, use of β blocker or digoxin were more common in patients with AF and HFNEF. The rates of ischaemic stroke, death and composite of ischaemic stroke and death were higher in patients with AF and HFNEF than in those with AF only (20.6% vs 6.7%, p<0.001; 27.2% vs 2.0%, p<0.001; 41.2% vs 8.1%, p<0.001 at 3 years for AF with HFNEF vs AF only, respectively). After adjustment with propensity score method using the inverse probability of treatment weighting, the 3-year risks of for ischaemic stroke (HR 3.29; 95% CI 1.58 to 6.86; p=0.001), death (HR 5.52; 95% CI 2.24 to 13.63; p<0.001), and composite of ischaemic stroke and death (HR 4.08; 95% CI 2.30 to 7.26; p<0.001) were significantly higher in patients with AF and HFNEF.
HFNEF is associated with an increased risk of stroke and death in patients with AF.
本研究旨在探讨射血分数正常的心力衰竭（HFNEF）合并心房颤动（AF）患者发生中风的风险。
回顾性调查了未接受抗凝治疗的非瓣膜性 AF 患者的临床和超声心动图数据。共 304 例患者无心力衰竭合并 AF，102 例患者诊断为 HFNEF 合并 AF。
比较两组缺血性中风、死亡及两者综合的发生率。
HFNEF 合并 AF 患者比单纯 AF 患者年龄更大（71.6 岁比 64.0 岁，p<0.001）。女性、糖尿病、高血压、慢性肾脏病、心绞痛、心肌梗死、β受体阻滞剂或地高辛的使用率在 HFNEF 合并 AF 患者中更高。HFNEF 合并 AF 患者的缺血性中风、死亡和缺血性中风及死亡综合发生率均高于单纯 AF 患者（20.6%比 6.7%，p<0.001；27.2%比 2.0%，p<0.001；41.2%比 8.1%，p<0.001，3 年时 HFNEF 合并 AF 比单纯 AF）。采用逆概率治疗加权法进行倾向评分匹配后，HFNEF 合并 AF 患者 3 年时发生缺血性中风的风险（HR 3.29；95%CI 1.58 至 6.86；p=0.001）、死亡风险（HR 5.52；95%CI 2.24 至 13.63；p<0.001）和缺血性中风及死亡综合风险（HR 4.08；95%CI 2.30 至 7.26；p<0.001）显著更高。
HFNEF 与 AF 患者中风和死亡风险增加相关。
