Liu Yongrong, Hong Yali
Department of Cardiovascular Medicine, People's Hospital of Chongqing Hechuan, Chongqing, China.
Front Cardiovasc Med. 2023 Jan 9;9:1029012. doi: 10.3389/fcvm.2022.1029012. eCollection 2022.
β-blockers have been recommended for patients with heart failure (HF) and atrial fibrillation (AF), but studies have shown that β-blockers do not reduce all-cause mortality or cardiovascular mortality in patients with HF and AF.
To investigate the difference in efficacy between oral amiodarone and metoprolol succinate for patients with HF with reduced ejection fraction (HFrEF) and persistent atrial fibrillation (pAF) with rapid ventricular response (RVR).
Patients with HFrEF complicated with pAF with RVR treated in the People's Hospital of Chongqing Hechuan between March 2018 and March 2019 were enrolled in this prospective observational study. The primary outcomes were cardiovascular mortality and the first hospitalization for HF rate. The secondary outcomes were type B pro-brain natriuretic peptide (NT-proBNP) before/after treatment, left ventricular ejection fraction (LVEF) before/after treatment, average heart rate (AhR), and the rate of sinus rhythm after 1 year of follow-up.
A total of 242 patients with HFrEF complicated with pAF with RVR were enrolled and divided into amiodarone + perindopril + spironolactone+ routine drug (amiodarone group, = 121) and metoprolol succinate + perindopril + spironolactone +routine drug (metoprolol succinate group, = 121) according to their treatment strategy. Cardiovascular mortality (4.9 vs. 12.4%, HR: 2.500, 95%CI: 1.002-6.237, = 0.040) and first hospitalization for HF (52.9 vs. 67.8%, HR: 1.281, 95%CI: 1.033-1.589, = 0.024) were significantly lower in the amiodarone group than in the metoprolol group. The mean ventricular rate in the amiodarone group was significantly lower than in the metoprolol group (64.5 ± 3.2 vs. 72.4 ± 4.2, < 0.001). After 1 year of follow-up, the sinus rhythm rate was significantly higher in the amiodarone group than in the metoprolol group (38.8 vs. 7.4%, HR: 0.191, 95%CI: 0.098-0.374, < 0.001). The difference in proBNP (3,914.88 vs. 2,558.07, < 0.001) and LVEF (-6.89 vs. -0.98, < 0.001) before and after treatment was significantly higher in the amiodarone group than in the metoprolol group.
In conclusion, in this prospective observational study, the amiodarone group had lower risk of cardiovascular death and the first hospitalization for HF than metoprolol in HFrEF and persistent atrial fibrillation (pAF) with RVR. The mechanism may be related to improved cardiac function, rhythm control and ventricular rate control.
ChiCTR2200057816; Registered 7 March 2022-Retrospectively registered: http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=4222.
β受体阻滞剂已被推荐用于心力衰竭（HF）和心房颤动（AF）患者，但研究表明，β受体阻滞剂并不能降低HF合并AF患者的全因死亡率或心血管死亡率。
探讨口服胺碘酮与琥珀酸美托洛尔对射血分数降低的心力衰竭（HFrEF）合并持续性心房颤动（pAF）且心室率快速（RVR）患者疗效的差异。
选取2018年3月至2019年3月在重庆市合川区人民医院治疗的HFrEF合并pAF且RVR患者，纳入本前瞻性观察性研究。主要结局为心血管死亡率和首次因HF住院率。次要结局为治疗前后B型脑钠肽前体（NT-proBNP）、治疗前后左心室射血分数（LVEF）、平均心率（AhR）以及随访1年后的窦性心律率。
共纳入242例HFrEF合并pAF且RVR患者，根据治疗策略分为胺碘酮+培哚普利+螺内酯+常规药物组（胺碘酮组，n = 121）和琥珀酸美托洛尔+培哚普利+螺内酯+常规药物组（琥珀酸美托洛尔组，n = 121）。胺碘酮组的心血管死亡率（4.9% vs. 12.4%，HR：2.500，95%CI：1.002 - 6.237，P = 0.040）和首次因HF住院率（52.9% vs. 67.8%，HR：1.281，95%CI：1.033 - 1.589，P = 0.024）显著低于美托洛尔组。胺碘酮组的平均心室率显著低于美托洛尔组（64.5 ± 3.2 vs. 72.4 ± 4.2，P < 0.001）。随访1年后，胺碘酮组的窦性心律率显著高于美托洛尔组（38.8% vs. 7.4%，HR：0.191，95%CI：0.098 - 0.374，P < 0.001）。胺碘酮组治疗前后proBNP（3914.88 vs. 2558.07，P < 0.001）和LVEF（-6.89 vs. -0.98，P < 0.001）的差异显著高于美托洛尔组。
总之，在本前瞻性观察性研究中，对于HFrEF合并持续性心房颤动（pAF）且RVR患者，胺碘酮组的心血管死亡风险和首次因HF住院风险低于美托洛尔组。其机制可能与心脏功能改善、节律控制和心室率控制有关。
ChiCTR2200057816；注册时间：2022年3月7日 - 回顾性注册：http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj = 4222
