Centro Hospitalar Universitário Lisboa Central, Hospital de Santa Marta, Lisbon - Portugal.
Arq Bras Cardiol. 2020 Feb;114(2):209-218. doi: 10.36660/abc.20180193.
Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients.
To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection.
Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant.
There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group.
Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.
心房颤动（AF）与心力衰竭（HF）患者的死亡率增加有关。
评估 AF 患者的风险是否可以通过与心肺运动试验（CPET）用于心脏移植（HT）选择的截止值的关系进行精确分层。
对 274 例连续左心室射血分数≤40%的 HF 患者进行前瞻性评估。主要终点是 1 年随访时的心脏死亡或紧急 HT 的复合终点。通过 CPET 参数的多个参数对主要终点进行分析，以获得最高曲线下面积，以及 AF 和窦性节律（SR）患者的阳性（PPV）和阴性预测值（NPV），以检测当前 HT 选择的截止值是否可以精确分层 AF 组。具有 p 值<0.05 的统计差异被认为具有显著性。
AF 组有 51 例患者，SR 组有 223 例患者。AF 组的主要结局更高（17.6%比 8.1%，p=0.038）。用于 HT 选择的 pVO2 截止值在 AF 组中对主要结局的 PPV 为 100%，NPV 为 95.5%，而在 SR 组中 PPV 为 38.5%，NPV 为 94.3%。VE/VCO2 斜率的截止值在 AF 组中的 PPV（33.3%）和 NPV（92.3%）均低于 pVO2 结果。
尽管 AF 使 HF 患者的预后更差，但当前用于 HT 选择的 pVO2 截止值可以精确分层这一高危组。
