Nakatani Daisaku, Dohi Tomoharu, Takeda Toshihiro, Okada Katsuki, Sunaga Akihiro, Oeun Bolrathanak, Kida Hirota, Sotomi Yohei, Sato Taiki, Kitamura Tetsuhisa, Suna Shinichiro, Mizuno Hiroya, Hikoso Shungo, Matsumura Yasushi, Sakata Yasushi
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan.
Department of Medical Informatics, Osaka University Graduate School of Medicine Suita Japan.
Circ Rep. 2022 Apr 23;4(6):255-263. doi: 10.1253/circrep.CR-22-0006. eCollection 2022 Jun 10.
Few data are available regarding the impact of atrial fibrillation (AF) at diagnosis and type of AF during the follow-up period on long-term outcomes in patients with heart failure with preserved ejection fraction (HFpEF). In all, 1,697 patients diagnosed as HFpEF between March 2010 and December 2017 were included in this study. At enrollment, 698 (41.1%) patients had AF. Over a median follow-up of 1,017 days, there were no significant differences between patients with and without AF in the adjusted hazard ratio (HR) for all-cause death or admission for heart failure. However, those with AF had a higher risk of stroke (HR 1.831; P=0.003). Of 998 patients with sinus rhythm at enrollment, 139 (13.9%) developed new-onset AF. Predictors of new-onset AF were pulse, hemoglobin, left ventricular end-diastolic dimension, and B-type natriuretic peptide. Compared with sinus rhythm, paroxysmal AF had a similar risk for all-cause death, admission for HF, and stroke; persistent AF had a lower risk of all-cause death (HR 0.701; P=0.015), but a higher risk for admission for HF (HR 1.608; P=0.002); and new-onset AF had a lower risk for all-cause death (HR 0.654; P=0.040), but a higher risk of admission for HF (HR 2.475; P<0.001). In patients with HFpEF, long-term outcome may differ by type of AF. Physicians need to consider individual risk with regard to AF type.
关于射血分数保留的心力衰竭（HFpEF）患者诊断时心房颤动（AF）及随访期间AF类型对长期预后的影响，目前可用数据较少。本研究纳入了2010年3月至2017年12月期间诊断为HFpEF的1697例患者。入组时，698例（41.1%）患者患有AF。在中位随访1017天期间，有AF和无AF患者在全因死亡或因心力衰竭住院的校正风险比（HR）方面无显著差异。然而，有AF的患者发生卒中的风险更高（HR 1.831；P = 0.003）。在入组时窦性心律的998例患者中，139例（13.9%）发生了新发AF。新发AF的预测因素为脉搏、血红蛋白、左心室舒张末期内径和B型利钠肽。与窦性心律相比，阵发性AF在全因死亡、因HF住院和卒中方面风险相似；持续性AF全因死亡风险较低（HR 0.701；P = 0.015），但因HF住院风险较高（HR 1.608；P = 0.002）；新发AF全因死亡风险较低（HR 0.654；P = 0.040），但因HF住院风险较高（HR 2.475；P < 0.001）。在HFpEF患者中，长期预后可能因AF类型而异。医生需要考虑AF类型的个体风险。
