Chouairi Fouad, Pacor Justin, Miller P Elliott, Fuery Michael A, Caraballo Cesar, Sen Sounok, Leifer Eric S, Felker G Michael, Fiuzat Mona, O'Connor Christopher M, Januzzi James L, Friedman Daniel J, Desai Nihar R, Ahmad Tariq, Freeman James V
Section of Cardiovascular Medicine, Yale University, New Haven, CT.
Yale School of Medicine, Yale University, New Haven, CT.
Mayo Clin Proc Innov Qual Outcomes. 2021 Apr 8;5(2):447-455. doi: 10.1016/j.mayocpiqo.2021.02.005. eCollection 2021 Apr.
To evaluate effects of atrial fibrillation (AF) on cardiac biomarkers and outcomes in a trial population of patients with heart failure (HF) with reduced ejection fraction treated with optimal guideline-directed medical therapy.
We performed a secondary analysis of 894 patients in the Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure (GUIDE-IT) trial (January 2013-July 2016). Patients were stratified by AF status and compared with regard to guideline-directed medical therapy use, longitudinal levels of N-terminal pro-B type natriuretic peptide (NT-proBNP), and outcomes including HF hospitalization and mortality.
After adjustment, AF was associated with a significant increase in the risk of HF hospitalization or cardiovascular death (hazard ratio, 1.28; 95% CI, 1.02 to 1.61; =0.04) and HF hospitalization (hazard ratio, 1.31; 95% CI, 1.02 to 1.68; =.03) but with no difference in mortality during a median 15 months of follow-up. There were no significant differences in medication treatment between those with and those without AF. At 90 days, a higher proportion of patients with AF (89.4% vs 81.5%; =.002) had an NT-proBNP level above 1000 pg/mL (to convert NT-proBNP values to pmol/L, multiply by 0.1182), and AF patients had higher NT-proBNP levels at all time points through 2 years of follow-up.
Among patients with HF with reduced ejection fraction, prevalent AF was associated with higher NT-proBNP concentrations through 2 years of follow-up and higher risk for HF hospitalization despite no substantial differences in medical therapy.
在一项针对射血分数降低的心力衰竭（HF）患者进行最佳指南指导药物治疗的试验人群中，评估心房颤动（AF）对心脏生物标志物及预后的影响。
我们对心力衰竭生物标志物强化治疗指导循证治疗（GUIDE-IT）试验（2013年1月至2016年7月）中的894例患者进行了二次分析。患者按房颤状态分层，并就指南指导药物治疗的使用情况、N末端B型利钠肽原（NT-proBNP）的纵向水平以及包括心力衰竭住院和死亡率在内的预后进行比较。
调整后，房颤与心力衰竭住院或心血管死亡风险显著增加相关（风险比，1.28；95%置信区间，1.02至1.61；P = 0.04）以及心力衰竭住院（风险比，1.31；95%置信区间，1.02至1.68；P = 0.03），但在中位15个月的随访期间死亡率无差异。有房颤和无房颤患者在药物治疗方面无显著差异。在90天时，房颤患者中NT-proBNP水平高于1000 pg/mL的比例更高（89.4%对81.5%；P = 0.002）（将NT-proBNP值换算为pmol/L，乘以0.1182），并且在长达2年的随访期间，房颤患者在所有时间点的NT-proBNP水平都更高。
在射血分数降低的心力衰竭患者中，尽管药物治疗无实质性差异，但在长达2年的随访中，持续性房颤与更高的NT-proBNP浓度以及更高的心力衰竭住院风险相关。
