Xiong Qinmei, Proietti Marco, Senoo Keitaro, Lip Gregory Y H
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, China.
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; I Clinica Medica, Sapienza-University of Rome, Rome, Italy.
Int J Cardiol. 2015 Jul 15;191:172-7. doi: 10.1016/j.ijcard.2015.05.011. Epub 2015 May 7.
Up to 40% of atrial fibrillation (AF) patients are asymptomatic. Despite this, scarce data are available about asymptomatic AF, with regard to its clinical profile and relationship to cerebrovascular and cardiovascular risks. Our objective was to conduct a systematic review and meta-analysis was to study the relationship between age and gender with asymptomatic AF and to establish whether patients with asymptomatic AF have a higher risk of death (all-cause and cardiovascular) and stroke/systemic thromboembolism, when compared to symptomatic AF patients. After a comprehensive search, 6 studies (2 randomized clinical trials and 4 observational studies) were entered in the meta-analysis. Despite significant heterogeneity, our data show that the prevalence of females amongst asymptomatic AF group was significantly less compared to the symptomatic AF group (RR, 0.57; 95% CI: 0.52-0.64). No difference in age between asymptomatic and symptomatic AF patients (P=0.72) was seen. No differences were found in all-cause death between patients with asymptomatic and symptomatic AF (RR, 1.38; 95% CI: 0.82-2.17), nor in cardiovascular death (RR, 0.85; 95% CI: 0.53-1.36) or stroke/thromboembolism (RR, 1.72 95% CI: 0.59-5.08). Asymptomatic AF is more associated with male sex, irrespective of age. Both general and cardiovascular death risks as well as thromboembolic risk do not seem to be affected by the asymptomatic clinical status. Symptomatic status should not determine our approach to stroke prevention and other cardiovascular prevention therapies, amongst patients with AF.
高达40%的心房颤动（AF）患者无症状。尽管如此，关于无症状性AF的临床特征及其与脑血管和心血管风险的关系，现有数据却很匮乏。我们的目的是进行一项系统评价和荟萃分析，以研究年龄和性别与无症状性AF之间的关系，并确定与有症状的AF患者相比，无症状性AF患者是否有更高的死亡（全因和心血管原因）风险以及中风/全身性血栓栓塞风险。经过全面检索，6项研究（2项随机临床试验和4项观察性研究）被纳入荟萃分析。尽管存在显著异质性，但我们的数据显示，与有症状的AF组相比，无症状性AF组中女性的患病率显著更低（风险比，0.57；95%置信区间：0.52 - 0.64）。未发现无症状和有症状的AF患者在年龄上有差异（P = 0.72）。在无症状和有症状的AF患者之间，全因死亡（风险比，1.38；95%置信区间：0.82 - 2.17）、心血管死亡（风险比，0.85；95%置信区间：0.53 - 1.36）或中风/血栓栓塞（风险比，1.72；95%置信区间：0.59 - 5.08）方面均未发现差异。无论年龄如何，无症状性AF与男性的关联更强。一般死亡风险和心血管死亡风险以及血栓栓塞风险似乎都不受无症状临床状态的影响。在AF患者中，症状状态不应决定我们预防中风和其他心血管疾病的治疗方法。
