主动脉瓣狭窄中的心房颤动——超声心动图评估及预后意义。
Atrial fibrillation in aortic stenosis--echocardiographic assessment and prognostic importance.
作者信息
Burup Kristensen Charlotte, Jensen Jan Skov, Sogaard Peter, Carstensen Helle Gervig, Mogelvang Rasmus
机构信息
Copenhagen University Hospital Gentofte, Department of Cardiology P835, Niels Andersens vej 65, DK-2900, Hellerup, Denmark.
出版信息
Cardiovasc Ultrasound. 2012 Sep 25;10:38. doi: 10.1186/1476-7120-10-38.
BACKGROUND
Atrial fibrillation (AFib) exists more frequently in patients with aortic stenosis (AS) than in patients without, and AFib may be a sign of progressive deterioration of AS. Echocardiographic assessment of AS in sinus rhythm is well documented, however, little is known about AFib in AS since such patients often are excluded from clinical echocardiographic trials.
AIM
The purpose of this study was to assess the prognostic importance of AFib in AS.
METHODS
The study was designed as a single-center case-control study. Patients with AS and AFib were enrolled as cases (n = 103) and subsequently matched to controls (103 patients with AS but sinus rhythm). Cases and controls were matched according to age, gender and severity of AS. Primary outcome was all cause mortality and follow-up was 100% complete.
RESULTS
Compared to controls the group with AFib had lower mean ejection fraction (42% vs. 49%; p < 0.001) and stroke volume (47 mL vs. 55 mL; p = 0.004), but higher heart rate (81 bpm vs. 68 bpm; p < 0.001) and no significant difference with regard to cardiac output (3.8 L vs. 4.0 L; p = 0.29). Accordingly, aortic jet velocity and gradients were significantly lower in AFib compared to controls but there were no differences (p = 0.38) in aortic valve area calculated by the continuity equation. During a median follow-up of 2.3 years (IQR: 1.2-3.6), 70 (34%) patients with AS died: 42 patients with AFib and 28 patients with sinus rhythm (p < 0.02). After adjusting for echocardiographic significant differences, AFib remained an independent predictor of mortality (HR 2.72 (95% CI: 1.12-6.61), p < 0.03). There was no significant interaction (p = 0.62) between AFib and AS on the risk of mortality, indicating that AFib predicted bad outcome regardless of the severity of AS.
CONCLUSIONS
AFib is an independent risk factor in patients with AS and the prognostic impact of AFib seems to be the same despite the severity of AS.
背景
与无主动脉瓣狭窄（AS）的患者相比，心房颤动（AFib）在AS患者中更为常见，且AFib可能是AS进行性恶化的一个迹象。窦性心律时AS的超声心动图评估已有充分记录，然而，由于此类患者常被排除在临床超声心动图试验之外，关于AS合并AFib的情况知之甚少。
目的
本研究旨在评估AFib在AS中的预后重要性。
方法
本研究设计为单中心病例对照研究。将患有AS且合并AFib的患者纳入病例组（n = 103），随后与对照组（103例患有AS但为窦性心律的患者）进行匹配。病例组和对照组根据年龄、性别和AS严重程度进行匹配。主要结局为全因死亡率，随访完成率为100%。
结果
与对照组相比，AFib组的平均射血分数较低（42%对49%；p < 0.001），每搏输出量较低（47 mL对55 mL；p = 0.004），但心率较高（81次/分钟对68次/分钟；p < 0.001），心输出量无显著差异（3.8 L对4.0 L；p = 0.29）。因此，与对照组相比，AFib组的主动脉射流速度和压力阶差显著较低，但通过连续方程计算的主动脉瓣面积无差异（p = 0.38）。在中位随访2.3年（四分位间距：1.2 - 3.6年）期间，70例（34%）AS患者死亡：42例合并AFib的患者和28例窦性心律的患者（p < 0.02）。在对超声心动图显著差异进行校正后，AFib仍然是死亡率的独立预测因素（风险比2.72（95%置信区间：1.12 - 6.61），p < 0.03）。AFib和AS在死亡风险方面无显著交互作用（p = 0.62），这表明无论AS严重程度如何，AFib均预示不良结局。
结论
AFib是AS患者的独立危险因素，且无论AS严重程度如何，AFib的预后影响似乎相同。
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