From the Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (R.K.S.); Division of Cardiac Electrophysiology, J.W. Goethe University, Frankfurt, Germany (S.H.H.); Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.A.P.); Division of Neurology (R.G.H.), Division of Cardiology (S.Y., S.J.C., J.S.H.), Population Health Research Institute (F.Y.), McMaster University, Hamilton, ON, Canada; The Canadian VIGOUR Center, Edmonton, Alberta, Canada (F.A.M.); and Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.).
Stroke. 2015 Mar;46(3):667-72. doi: 10.1161/STROKEAHA.114.007140. Epub 2015 Jan 27.
Limited data exists regarding the relationship between left ventricular systolic dysfunction (LVSD) and heart failure (HF) symptoms and embolic risk among patients with atrial fibrillation.
Participants in the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) trials with HF, but not randomized to oral anticoagulation, were categorized as having preserved versus reduced ejection fraction. If reduced, LVSD was classified as mild, moderate, or severe. Symptoms were quantified using New York Heart Association class.The primary outcome was a composite of stroke, transient ischemic attack, and systemic embolism.
There were 3487 antiplatelet-treated patients with HF at baseline. Of these patients, 969 (46.8%) had HF with preserved ejection fraction and 1103 (53.2%) had HF with reduced ejection fraction. During 3.6 years of mean follow-up, first occurrence of stroke, transient ischemic attack, or systemic embolism occurred in 386 patients.The strongest independent predictors of embolic events were age ≥75 years (hazard ratio 2.55; confidence interval, 1.85-3.53), prior stroke or transient ischemic attack (hazard ratio 2.07; 95% confidence interval, 1.65-2.60), and female sex (hazard ratio 1.37; confidence interval, 1.11-1.69). However, ejection fraction <0.50, degree of LVSD, and New York Heart Association class did not predict embolic events. Patients with HF with preserved ejection fraction exhibited similar risk of embolic events as those with HR with reduced ejection fraction: 4.3% versus 4.4% per 100 person-years (hazard ration 1.01; 95% confidence interval, 0.78-1.31). Risk of embolic events was similar across categories of LVSD (P for trend =0.96) and New York Heart Association class (P for trend =0.57).
Among HF patients in ACTIVE, neither the presence of LVSD or degree of symptom severity influenced risk of embolic events.
左心室收缩功能障碍（LVSD）与心力衰竭（HF）症状以及房颤患者栓塞风险之间的关系的数据有限。
ACTIVE 试验中存在 HF，但未随机接受口服抗凝治疗的房颤患者被分为射血分数保留与射血分数降低。如果射血分数降低，则将 LVSD 分为轻度、中度或重度。使用纽约心脏协会（NYHA）心功能分级来量化症状。主要结局是卒中、短暂性脑缺血发作和全身性栓塞的复合事件。
基线时有 3487 例接受抗血小板治疗的 HF 患者。其中，969 例（46.8%）HF 伴有射血分数保留，1103 例（53.2%）HF 伴有射血分数降低。在平均 3.6 年的随访期间，386 例患者首次发生卒中、短暂性脑缺血发作或全身性栓塞。栓塞事件的最强独立预测因素是年龄≥75 岁（风险比 2.55；置信区间，1.85-3.53）、既往卒中和短暂性脑缺血发作（风险比 2.07；95%置信区间，1.65-2.60）和女性（风险比 1.37；置信区间，1.11-1.69）。然而，射血分数<0.50、LVSD 程度和 NYHA 心功能分级不能预测栓塞事件。射血分数保留的 HF 患者与射血分数降低的 HF 患者发生栓塞事件的风险相似：每 100 人年 4.3%与 4.4%（风险比 1.01；95%置信区间，0.78-1.31）。LVSD 各分类（趋势检验 P=0.96）和 NYHA 心功能分级（趋势检验 P=0.57）之间的栓塞事件风险相似。
在 ACTIVE 试验的 HF 患者中，LVSD 的存在或症状严重程度均不能影响栓塞事件的风险。
