Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.
Int J Cardiol. 2018 Jun 1;260:93-98. doi: 10.1016/j.ijcard.2018.03.017. Epub 2018 Mar 7.
We compared thromboembolic (TE) and bleeding risks in patients with atrial fibrillation (AF) according to the new 'Evaluated Heartvalves, Rheumatic or Artificial' (EHRA) valve classification.
Patients were divided into 3 categories: (i) EHRA type 1 corresponds to the previous 'valvular' AF patients, with either rheumatic mitral valve stenosis or mechanical prosthetic heart valves; (ii) EHRA type 2 includes AF patients with other valvular heart disease (VHD) and valve bioprosthesis or repair; and (iii) 'non-VHD controls' i.e. all AF patients with neither VHD nor post-surgical valve disease.
Among 8962 AF patients seen between 2000 and 2010, 357 (4%) were EHRA type 1, 1754 (20%) were EHRA type 2 and 6851 (76%) non-VHD controls. EHRA type 2 patients were older and had a higher CHADS-VASc and HAS-BLED scores than either type 1 and non-VHD patients. After a mean follow-up of 1264 ± 1160 days, the occurrence of TE events was higher in EHRA type 2 than non-VHD patients (HR (95%CI): 1.30 1.09-1.54), p = 0.003; also, p = 0.31 for type 1 vs 2, p = 0.68 for type 1 vs non-VHD controls). The rate of major BARC bleeding events for AF patients was higher in either EHRA type 1 (HR (95%CI): 3.16(2.11-4.72), p < 0.0001) or type 2 (HR (95%CI): 2.19(1.69-2.84), p < 0.0001) compared to non-VHD controls.
The EHRA valve classification of AF patients with VHD appears useful in categorizing these patients, in terms of TE and bleeding risks. This classification can be used in clinical practice for appropriate choices of oral anticoagulation therapy and follow-up.
我们比较了根据新的“评估心脏瓣膜、风湿或人工”（EHRA）瓣膜分类的心房颤动（AF）患者的血栓栓塞（TE）和出血风险。
患者被分为 3 类：（i）EHRA 1 型对应于以前的“瓣膜性”AF 患者，有风湿性二尖瓣狭窄或机械人工心脏瓣膜；（ii）EHRA 2 型包括有其他瓣膜性心脏病（VHD）和瓣膜生物假体或修复的 AF 患者；和（iii）“非 VHD 对照组”，即既无 VHD 也无手术后瓣膜疾病的所有 AF 患者。
在 2000 年至 2010 年间观察到的 8962 例 AF 患者中，357 例（4%）为 EHRA 1 型，1754 例（20%）为 EHRA 2 型，6851 例（76%）为非 VHD 对照组。EHRA 2 型患者年龄较大，CHADS-VASc 和 HAS-BLED 评分高于 1 型和非 VHD 患者。平均随访 1264±1160 天后，EHRA 2 型患者的 TE 事件发生率高于非 VHD 患者（HR（95%CI）：1.30[1.09-1.54]），p=0.003；EHRA 1 型与 2 型相比，p=0.31，EHRA 1 型与非 VHD 对照组相比，p=0.68）。EHRA 1 型（HR（95%CI）：3.16[2.11-4.72]，p<0.0001）或 2 型（HR（95%CI）：2.19[1.69-2.84]，p<0.0001）AF 患者的主要 BARC 出血事件发生率均高于非 VHD 对照组。
EHRA 瓣膜分类对 VHD 的 AF 患者在 TE 和出血风险方面似乎有用。该分类可用于临床实践，以选择适当的口服抗凝治疗和随访。
