Salam A M, Gersh B J, AlBinali H A, Singh R, Asaad N, Al-Qahtani A, Suwaidi J A
Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar.
Int J Clin Pract. 2014 Jan;68(1):122-9. doi: 10.1111/ijcp.12230.
It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry.
Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed.
During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03).
Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.
众所周知，房颤（AF）患者的临床表现各异，从典型的心悸症状到其他非典型症状，还有相当一部分患者无症状。目前尚不清楚不同的表现形式是否与预后差异相关。本研究的目的是评估在一个大型前瞻性登记处中因房颤住院的患者中心悸缺失的患病率及其预后意义。
对1991年至2010年在卡塔尔因房颤住院的所有患者进行回顾性分析。根据就诊时是否有心悸将患者分为两组。分析临床特征和预后。
在这20年期间，3850例患者因房颤住院；1724例（44.8%）就诊时有心悸，而2126例（55.2%）没有心悸。没有心悸的患者年龄大9岁，糖尿病患病率更高（64.7%对35.3%），有潜在冠状动脉疾病（CAD；14.6%对6.2%），超声心动图显示严重左心室功能障碍的比例更高（25.5%对6.6%），（所有比较，p = 0.001）。无心悸组有141例死亡，有心悸组有19例死亡（6.6%对1.1%）。对死亡预测因素的多变量分析确定“心悸缺失”是住院死亡率的独立预测因素（相对风险5.56；95%置信区间1.20 - 25.0，p = 0.03）。
我们的研究首次表明，房颤患者以心悸缺失作为首发症状与更差的住院结局相关，且独立于其他风险因素或治疗。潜在机制和混杂因素的作用值得进一步研究。
