Nuzzi Vincenzo, Cannatà Antonio, Manca Paolo, Castrichini Matteo, Barbati Giulia, Aleksova Aneta, Fabris Enrico, Zecchin Massimo, Merlo Marco, Boriani Giuseppe, Sinagra Gianfranco
Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy.
Int J Cardiol. 2021 Jan 15;323:140-147. doi: 10.1016/j.ijcard.2020.08.062. Epub 2020 Aug 25.
Little is known about the role of different types of atrial fibrillation (AF) in dilated cardiomyopathy (DCM). We investigated the epidemiological and prognostic impact of different types of AF in DCM during long-term follow-up.
We evaluated consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry. Uni- and multivariable, extended Kaplan-Meier and propensity score-matching analyses were performed for a composite outcome including death/heart transplantation/ventricular-assist device implantation.
Out of 1181 DCM patients (71% males, age 49 ± 15 years, left ventricular ejection fraction 33 ± 11%), 46 (3.9%) had baseline permanent AF (permAF), while 66 (5.6%) had a history of paroxysmal/persistent AF. Compared with sinus rhythm (SR) patients, permAF patients were older (48 ± 15 vs. 61 ± 11 respectively, p = 0.001), were more frequently in NYHA class III-IV (18% vs. 30%, p = 0.002) and had larger left atrium diameter (40 ± 8 vs. 50 ± 10 mm, respectively). Paroxysmal/persistent AF patients had intermediate characteristics between permAF and SR. During a median follow-up of 135 (75-210) months, 63 patients developed permAF (0.45 new cases/100patients/year). At multivariable analysis, permAF as a time-dependent variable was an independent outcome predictor (HR 2.45; 95% C.I. 2.61-3.63, p < 0.001), together with creatinine, NYHA class, restrictive filling pattern and moderate-severe mitral regurgitation, while paroxysmal/persistent AF was neutral. Propensity score-matching analysis confirmed the higher rate of primary outcome events in patients with baseline or incident permAF versus patients without permAF during a very long-term follow-up (70% vs. 20%, p < 0.001).
PermAF in a large DCM cohort had low prevalence and incidence but had a relevant. prognostic role on hard outcomes.
关于不同类型心房颤动（AF）在扩张型心肌病（DCM）中的作用，人们了解甚少。我们在长期随访中研究了不同类型AF对DCM的流行病学及预后影响。
我们评估了纳入的里雅斯特肌肉心脏病登记处的连续性DCM患者。对包括死亡/心脏移植/心室辅助装置植入在内的复合结局进行单变量和多变量、扩展Kaplan-Meier分析及倾向得分匹配分析。
在1181例DCM患者中（71%为男性，年龄49±15岁，左心室射血分数33±11%），46例（3.9%）有基线永久性AF（permAF），而66例（5.6%）有阵发性/持续性AF病史。与窦性心律（SR）患者相比，permAF患者年龄更大（分别为48±15岁和61±11岁，p = 0.001），更频繁处于纽约心脏协会（NYHA）心功能III-IV级（18%对30%，p = 0.002），且左心房直径更大（分别为40±8mm和50±10mm）。阵发性/持续性AF患者的特征介于permAF和SR患者之间。在中位随访135（75 - 210）个月期间，63例患者发生了permAF（0.45例新发病例/100例患者/年）。在多变量分析中，作为时间依赖性变量的permAF是独立的结局预测因素（风险比2.45；95%置信区间2.61 - 3.63，p < 0.001），与肌酐、NYHA分级、限制性充盈模式及中重度二尖瓣反流一起，而阵发性/持续性AF则无显著影响。倾向得分匹配分析证实，在非常长期的随访中，有基线或新发permAF的患者与无permAF的患者相比，主要结局事件发生率更高（70%对20%，p < 0.001）。
在一大群DCM患者中，permAF的患病率和发病率较低，但对严重结局具有重要的预后作用。
