O'Neal Wesley T, Sandesara Pratik, Hammadah Muhammad, Venkatesh Sanjay, Samman-Tahhan Ayman, Kelli Heval M, Soliman Elsayed Z
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Cardiol. 2017 Jun 1;119(11):1785-1790. doi: 10.1016/j.amjcard.2017.02.045. Epub 2017 Mar 16.
Atrial fibrillation (AF) is associated with an increased risk for adverse events in patients with heart failure with preserved ejection fraction (HFpEF), but it is currently unknown if gender differences in these outcomes exist. To explore this hypothesis, we examined gender differences in the associations of AF with adverse outcomes in 3,385 (mean age 69 ± 9.6 years, 49% male, 89% white) patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial. Baseline AF cases were identified by self-reported history, medical record review, and baseline electrocardiogram data. Outcomes were adjudicated by a clinical end point committee and included the following: hospitalization, hospitalization for heart failure, stroke, death, and cardiovascular death. Cox regression was used to examine the risk of each outcome associated with AF. Over a median follow-up of 3.4 years, AF was associated with an increased risk for hospitalization (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.34 to 1.66), hospitalization for heart failure (HR 1.49, 95% CI 1.23 to 1.81), stroke (HR 2.10, 95% CI 1.43 to 2.09), death (HR 1.22, 95% CI 1.02 to 1.47), and cardiovascular death (HR 1.31, 95% CI 1.04 to 1.65). The association between AF and hospitalization was stronger in women (HR 1.63, 95% CI 1.40 to 1.91) than men (HR 1.37, 95% CI 1.18 to 1.58; p-interaction = 0.032). Although significant interactions were not observed for the other outcomes, we appreciated that the risk estimates were higher for women compared with men. In conclusion, AF increases the risk for adverse cardiovascular outcomes in patients with HFpEF, and the presence of this arrhythmia in women possibly is associated with a greater risk for adverse events than men.
心房颤动（AF）与射血分数保留的心力衰竭（HFpEF）患者发生不良事件的风险增加相关，但目前尚不清楚这些结果是否存在性别差异。为了探究这一假设，我们在醛固酮拮抗剂治疗射血分数保留的心力衰竭试验中的3385例（平均年龄69±9.6岁，49%为男性，89%为白人）HFpEF患者中，研究了AF与不良结局之间关联的性别差异。通过自我报告病史、病历审查和基线心电图数据确定基线AF病例。结局由临床终点委员会判定，包括以下内容：住院、因心力衰竭住院、中风、死亡和心血管死亡。采用Cox回归分析AF与各结局相关的风险。在中位随访3.4年期间，AF与住院风险增加相关（风险比[HR]1.49，95%置信区间[CI]1.34至1.66）、因心力衰竭住院（HR 1.49，95%CI 1.23至1.81）、中风（HR 2.10，95%CI 1.43至2.09）、死亡（HR 1.22，95%CI 1.02至1.47）和心血管死亡（HR 1.31，95%CI 1.04至1.65）。AF与住院之间的关联在女性中（HR 1.63，95%CI 1.40至1.91）比男性中（HR 1.37，95%CI 1.18至1.58；P交互作用=0.032）更强。尽管在其他结局中未观察到显著的交互作用，但我们注意到女性的风险估计值高于男性。总之，AF增加了HFpEF患者发生不良心血管结局的风险，并且女性出现这种心律失常可能比男性发生不良事件的风险更大。
