Uhm Jae-Sun, Kim Jun, Yu Hee Tae, Kim Tae-Hoon, Lee So-Ryoung, Cha Myung-Jin, Choi Eue-Keun, Lee Jung Myung, Kim Jin-Bae, Park Junbeom, Park Jin-Kyu, Kang Ki-Woon, Shim Jaemin, Park Hyung Wook, Lee Young Soo, Kim Chang-Soo, Mun Ji Eun, Son Nak-Hoon, Joung Boyoung
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
ESC Heart Fail. 2021 Apr;8(2):1582-1589. doi: 10.1002/ehf2.13264. Epub 2021 Feb 25.
This study aimed to elucidate the risk for stroke and systemic embolism (SE) in patients with atrial fibrillation and heart failure (HF) according to HF type.
A total of 10 780 patients with atrial fibrillation were enrolled in a multicentre prospective registry and divided according to HF type: no-HF, HF with preserved ejection fraction (EF) (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). Each group included 237 age-matched and sex-matched patients (age, 69.0 ± 10.3 years; men, 69.6%). The baseline characteristics, cumulative incidence, and hazard ratios for stroke/SE and major bleeding were compared across the groups. Patients with HF accounted for 10.3% of the total population; HFpEF, HFmrEF, and HFrEF represented 43.7%, 23.6%, and 32.7% of the patients with HF, respectively. The CHA DS -VASc score was significantly higher in the HFpEF, HFmrEF, and HFrEF groups than in the no-HF group. The annual stroke/SE incidence rates were 2.8%, 0.7%, 1.1%, and 0.9% in the HFpEF, HFmrEF, HFrEF, and no-HF groups, respectively. The cumulative incidence of stroke/SE was significantly highest in the HFpEF group at 22.8 ± 10.0 months (P = 0.020). The stroke/SE risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio, 3.192; 95% confidence interval, 1.039-9.810; P = 0.043). E/e' value was an independent risk factor for stroke/SE. There were no significant differences in the incidence of major bleeding across the groups.
The stroke/SE risk was the highest in the HFpEF group and comparable between the HFmrEF and HFrEF groups.
本研究旨在根据心力衰竭（HF）类型阐明心房颤动合并心力衰竭患者发生中风和全身性栓塞（SE）的风险。
共有10780例心房颤动患者纳入一项多中心前瞻性登记研究，并根据HF类型进行分组：无心衰、射血分数保留的心衰（HFpEF）、射血分数中等的心衰（HFmrEF）和射血分数降低的心衰（HFrEF）。每组包括237例年龄和性别匹配的患者（年龄69.0±10.3岁；男性占69.6%）。比较各组的基线特征、中风/SE和大出血的累积发生率及风险比。心衰患者占总人口的10.3%；HFpEF、HFmrEF和HFrEF分别占心衰患者的43.7%、23.6%和32.7%。HFpEF、HFmrEF和HFrEF组的CHA₂DS₂-VASc评分显著高于无心衰组。HFpEF、HFmrEF、HFrEF和无心衰组的年中风/SE发生率分别为2.8%、0.7%、1.1%和0.9%。HFpEF组中风/SE的累积发生率最高，为22.8±10.0个月（P=0.020）。HFpEF组的中风/SE风险高于HFmrEF和HFrEF组（风险比3.192；95%置信区间1.039-9.810；P=0.043）。E/e'值是中风/SE的独立危险因素。各组大出血发生率无显著差异。
HFpEF组中风/SE风险最高，HFmrEF组和HFrEF组相当。
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