Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
Heart. 2018 Aug;104(15):1276-1283. doi: 10.1136/heartjnl-2017-312573. Epub 2018 Jan 25.
Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.
We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.
Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.
In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.
肥厚型心肌病（HCM）合并心房颤动（AF）与死亡率增加相关，主要由血栓栓塞事件和进行性心力衰竭增加所介导。许多研究表明，肾素-血管紧张素-醛固酮系统（RAAS）抑制剂的应用可减少各种临床情况下的新发 AF。然而，RAAS 抑制剂在 HCM 中预防 AF 的效果仍不明确。本研究旨在探讨 ACEI 或血管紧张素受体阻滞剂（ARB）的治疗是否可以降低 HCM 中新发 AF 的风险。
我们进行了一项回顾性研究，纳入了国家健康研究机构涵盖的几乎所有台湾人组成的全国性数据库中，1997 年 1 月至 2013 年 12 月期间诊断为 HCM 的患者。所有参与者年龄均在 18 岁或以上，在入组前无 ACEI 或 ARB 暴露或 AF 诊断。采用倾向评分匹配和多变量 Cox 风险回归来评估新发 AF 发生的风险。
共纳入 18266 例患者，中位随访时间为 8.13 年。与未服用 ACEI 或 ARB 的患者相比，服用 ACEI 或 ARB 的患者新发 AF 的风险较低（3.16% vs. 5.65%，相对风险 0.56[95%CI 0.49 至 0.64]，HR 0.572[95%CI 0.480 至 0.683]）。这种相关性在 ACEI 或 ARB 治疗时间较长的患者中更为显著（T1 至 T3 时 HR 分别为 0.741、0.579、0.337，P<0.001）。经倾向评分调整后，结果仍保持一致。
在 HCM 患者中，与未服用 ACEI 或 ARB 的患者相比，服用 ACEI 或 ARB 的患者新发 AF 的风险较低。
