心房颤动是无缺血性心力衰竭患者死亡率增加的标志——来自 DANISH 试验的结果。

Atrial fibrillation is a marker of increased mortality risk in nonischemic heart failure-Results from the DANISH trial.

机构信息

Department of Cardiology, Amager Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark.

出版信息

Am Heart J. 2021 Feb;232:61-70. doi: 10.1016/j.ahj.2020.10.073. Epub 2020 Nov 2.

DOI:10.1016/j.ahj.2020.10.073

PMID:33144085

Abstract

BACKGROUND

Atrial fibrillation (AF) in heart failure (HF) patients has been associated with a worse outcome. Similarly, excessive supraventricular ectopic activity (ESVEA) has been linked to development of AF, stroke, and death. This study aimed to investigate AF and ESVEA's association with outcomes and effect of prophylactic implantable cardioverter defibrillator (ICD) implantation in nonischemic HF patients.

METHODS

A total of 850 patients with nonischemic HF, left ventricle ejection fraction ≤35%, and elevated N-terminal pro-brain natriuretic peptides underwent 24 hours Holter recording. The presence of AF (≥30 seconds) and ESVEA (≥30 supraventricular ectopic complexes (SVEC) per hour or run of SVEC ≥20 beats) were registered. Outcomes were all-cause mortality, cardiovascular death (CVD), and sudden cardiac death (SCD).

RESULTS

AF was identified in 188 patients (22%) and ESVEA in 84 patients (10%). After 4 years and 11 months of follow-up, a total of 193 patients (23%) had died. AF was associated with all-cause mortality (hazard ratio [HR] 1.44; confidence interval [CI] 1.04-1.99; P = .03) and CVD (HR 1.59; CI 1.07-2.36; P = .02). ESVEA was associated with all-cause mortality (HR 1.73; CI 1.16-2.57; P = .0073) and CVD (HR 1.76; CI 1.06-2.92; P = .03). Neither AF nor ESVEA was associated with SCD. ICD implantation was not associated with an improved prognosis for neither AF (P value for interaction = .17), nor ESVEA (P value for interaction = .68).

CONCLUSIONS

Both AF and ESVEA were associated with worsened prognosis in nonischemic HF. However, ICD implantation was not associated with an improved prognosis for either group.

摘要

背景

心房颤动（AF）在心力衰竭（HF）患者中与预后较差相关。同样，过度的室上性异位活动（ESVEA）与 AF、中风和死亡的发展有关。本研究旨在探讨 AF 和 ESVEA 与非缺血性 HF 患者结局的关系，以及预防性植入式心脏复律除颤器（ICD）植入的效果。

方法

共 850 例非缺血性 HF、左心室射血分数≤35%和 N 末端脑利钠肽前体升高的患者接受 24 小时 Holter 记录。记录 AF（≥30 秒）和 ESVEA（每小时≥30 个室上性异位搏动或≥20 个室上性搏动的搏动）的存在。结局为全因死亡率、心血管死亡率（CVD）和心源性猝死（SCD）。

结果

188 例（22%）患者存在 AF，84 例（10%）患者存在 ESVEA。随访 4 年 11 个月后，共有 193 例（23%）患者死亡。AF 与全因死亡率（风险比[HR] 1.44；置信区间[CI] 1.04-1.99；P=0.03）和 CVD（HR 1.59；CI 1.07-2.36；P=0.02）相关。ESVEA 与全因死亡率（HR 1.73；CI 1.16-2.57；P=0.0073）和 CVD（HR 1.76；CI 1.06-2.92；P=0.03）相关。AF 和 ESVEA 均与 SCD 无关。ICD 植入与 AF（交互 P 值=0.17）或 ESVEA（交互 P 值=0.68）的预后改善均无关。