心率对于房颤合并心力衰竭患者重要吗？
Is heart rate important for patients with heart failure in atrial fibrillation?
机构信息
Department of Cardiology, Postgraduate Medical Institute, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom.
Department of Cardiology, Postgraduate Medical Institute, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom.
出版信息
JACC Heart Fail. 2014 Jun;2(3):213-20. doi: 10.1016/j.jchf.2014.01.005. Epub 2014 Apr 30.
OBJECTIVES
This study sought to investigate the relationship between resting ventricular rate and mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) who were in sinus rhythm (SR) or atrial fibrillation (AF).
BACKGROUND
Slower heart rates are associated with better survival in patients with CHF in SR, but it is not clear whether this is true for those in AF.
METHODS
We assessed 2,039 outpatients with CHF and LVEF ≤50% undergoing baseline assessment, of whom 24% (n = 488) were in AF; and 841 outpatients reassessed after attempted treatment optimization at 1 year, of whom 22% (n = 184) were in AF. Cox proportional hazards models were used to assess the relationships between heart rate and survival in patients with CHF and AF or sinus rhythm. We analyzed heart rate and rhythm data recorded at the baseline review and after 1-year follow-up. Proportional hazards assumptions were checked by Schoenfeld and Martingale residuals.
RESULTS
The median survival for those in AF was 6.1 years (interquartile range [IQR]: 5.3 to 6.9 years) and 7.3 years (IQR: 6.5 to 8.1 years) for those in SR. In univariable analysis, patients with AF had a worse survival (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 1.08 to 1.47; p = 0.003) but after covariate adjustment, survival rates were similar. After adjusting Cox regression models, there was no association between heart rate (per 10 beats/min increments) and survival in patients with AF before (HR: 0.94, 95% CI: 0.88 to 1.00, p = 0.07) or after (HR: 1.00, 95% CI: 0.99 to 1.00, p = 0.84) therapy optimization. For patients in SR, higher heart rates were associated with worse survival, both before (HR: 1.10, 95% CI: 1.05 to 1.15, p <0.0001) and after (HR: 1.13, 95% CI: 1.03 to 1.24, p = 0.008) therapy optimization.
CONCLUSIONS
In patients with CHF and a reduced LVEF, slower resting ventricular rate is associated with better survival for patients in SR but not for those with AF.
目的
本研究旨在探讨窦性心律（SR）或心房颤动（AF）的慢性心力衰竭（CHF）合并左心室射血分数（LVEF）降低患者的静息心室率与死亡率之间的关系。
背景
在 SR 中的 CHF 患者中，较慢的心率与更好的生存相关，但对于 AF 患者是否如此尚不清楚。
方法
我们评估了 2039 名接受基线评估的 CHF 和 LVEF≤50%的门诊患者，其中 24%（n=488）为 AF；841 名在 1 年时进行了优化治疗后重新评估的门诊患者，其中 22%（n=184）为 AF。使用 Cox 比例风险模型评估 CHF 合并 AF 或窦性心律患者的心率与生存之间的关系。我们分析了基线检查和 1 年随访时记录的心率和节律数据。通过 Schoenfeld 和 Martingale 残差检查比例风险假设。
结果
AF 患者的中位生存时间为 6.1 年（四分位距[IQR]：5.3 至 6.9 年），SR 患者的中位生存时间为 7.3 年（IQR：6.5 至 8.1 年）。在单变量分析中，AF 患者的生存率较差（风险比[HR]：1.26，95%置信区间[CI]：1.08 至 1.47；p=0.003），但在调整协变量后，生存率相似。调整 Cox 回归模型后，AF 患者的心率（每增加 10 次/分钟）与生存之间无关联，无论是在治疗前（HR：0.94，95%CI：0.88 至 1.00，p=0.07）还是治疗后（HR：1.00，95%CI：0.99 至 1.00，p=0.84）。对于 SR 患者，较高的心率与生存率较差相关，无论是在治疗前（HR：1.10，95%CI：1.05 至 1.15，p<0.0001）还是治疗后（HR：1.13，95%CI：1.03 至 1.24，p=0.008）。
结论
在 CHF 合并 LVEF 降低的患者中，SR 患者的静息心室率较慢与生存率较好相关，而 AF 患者则不然。
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