Suzuki Sho, Motoki Hirohiko, Kanzaki Yusuke, Maruyama Takuya, Hashizume Naoto, Kozuka Ayako, Yahikozawa Kumiko, Kuwahara Koichiro
Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan.
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 3908621, Japan.
Heart Vessels. 2020 Aug;35(8):1109-1115. doi: 10.1007/s00380-020-01573-5. Epub 2020 Mar 6.
The prognostic significance of resting heart rate (HR) in atrial fibrillation (AF) patients with heart failure with reduced ejection fraction (HFrEF) is unclear, and there are no recommendations about the optimal HR in patients with HF in the current guidelines. Thus, we aimed to identify the relationship between resting HR and mortality in AF patients with HFrEF. A prospective multicenter cohort study was conducted between July 2014 and December 2018. We enrolled consecutive 144 AF patients with HFrEF (mean age 75 years, 34% female). The primary endpoint was all-cause death. We compared the outcomes between the high HR group (HR > 81 beats per minute [bpm], interquartile range [IQR] of HR ≥ 67%, n = 50), and the low HR group (HR ≤ 81 bpm, IQR of HR < 67%, n = 94). During a median follow-up of 538 days, the primary endpoint occurred in 41 (28.5%) patients. In Kaplan-Meier analysis, high HR was associated with a progressively increased risk of mortality (log-rank test, p = 0.034). After multivariate Cox regression analysis, high HR predicted all-cause death after adjusting for age, sex, hemoglobin, estimated glomerular filtration rate, LVEF, use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, digoxin, amiodarone, and calcium channel blockers (hazard ratio, 1.979; 95% confidence interval, 1.005-3.898; p = 0.048). Resting HR > 81 bpm at discharge had a significantly higher risk of death compared with HR ≤ 81 bpm in AF patients with HFrEF.
静息心率（HR）在射血分数降低的心力衰竭（HFrEF）合并心房颤动（AF）患者中的预后意义尚不清楚，目前指南中也没有关于HF患者最佳心率的建议。因此，我们旨在确定HFrEF合并AF患者静息心率与死亡率之间的关系。2014年7月至2018年12月进行了一项前瞻性多中心队列研究。我们连续纳入了144例HFrEF合并AF的患者（平均年龄75岁，34%为女性）。主要终点是全因死亡。我们比较了高心率组（HR>81次/分钟[bpm]，HR四分位间距[IQR]≥67%，n = 50）和低心率组（HR≤81 bpm，HR四分位间距<67%，n = 94）的结局。在中位随访538天期间，41例（28.5%）患者发生了主要终点事件。在Kaplan-Meier分析中，高心率与死亡率风险逐渐增加相关（对数秩检验，p = 0.034）。经过多变量Cox回归分析，在调整年龄、性别、血红蛋白、估计肾小球滤过率、左心室射血分数、使用血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂、β受体阻滞剂、地高辛、胺碘酮和钙通道阻滞剂后，高心率可预测全因死亡（风险比，1.979；95%置信区间，1.005 - 3.898；p = 0.048）。在HFrEF合并AF的患者中，出院时静息心率>81 bpm的患者死亡风险显著高于HR≤81 bpm的患者。
