School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea.
Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, South Korea.
Echocardiography. 2021 Oct;38(10):1787-1794. doi: 10.1111/echo.15216. Epub 2021 Oct 21.
Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with persistent atrial fibrillation (AF).
We evaluated the data of 114 consecutive patients with persistent AF who underwent measurement of LVEDP at our hospital between March 1, 2011 and December 31, 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP > 15 mm Hg and LVEDP ≤ 15 mm Hg subgroups. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mm Hg and LVEDP < 15 mm Hg groups.
During the 3-year follow-up period, the rate of heart failure (HF) hospitalization and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalization (hazard ratio, 4.71; 95% confidence interval, 1.48-15.02; p = 0.009).
Our mid-term follow-up data demonstrated that systolic dysfunction was an important predictor of HF hospitalization in patients with AF. However, elevated LVEDP may not be associated with adverse mid-term clinical outcomes in patients without systolic dysfunction.
在窦性心律患者中，收缩和舒张功能障碍与不良临床结局相关。本研究旨在阐明持续性心房颤动（AF）患者收缩和舒张功能障碍的预后意义。
我们评估了 2011 年 3 月 1 日至 2014 年 12 月 31 日期间在我院接受左心室舒张末期压（LVEDP）测量的 114 例连续持续性 AF 患者的数据。根据左心室射血分数（LVEF）将患者分为两组：LVEF<50（射血分数降低，REF 组）和 LVEF≥50（射血分数保留，PEF 组）。根据左心室舒张末期填充压（LVEDP）将 PEF 组进一步分为两组：LVEDP>15mmHg 和 LVEDP≤15mmHg 亚组。比较 PEF 组和 REF 组以及 LVEDP≥15mmHg 组和 LVEDP<15mmHg 组的 3 年临床结局。
在 3 年随访期间，REF 组心力衰竭（HF）住院率和快速心室节律（RVR）AF 发生率均高于 PEF 组。多变量分析显示，REF 是 HF 住院的唯一显著预测因子（危险比，4.71；95%置信区间，1.48-15.02；p=0.009）。
我们的中期随访数据表明，收缩功能障碍是 AF 患者 HF 住院的重要预测因子。然而，在没有收缩功能障碍的患者中，LVEDP 升高可能与不良中期临床结局无关。
