根据心力衰竭表型分析心房颤动患者发生心力衰竭、中风和出血的风险
Risks of Heart Failure, Stroke, and Bleeding in Atrial Fibrillation According to Heart Failure Phenotypes.
作者信息
Inciardi Riccardo M, Giugliano Robert P, Park Jeong-Gun, Nordio Francesco, Ruff Christian T, Chen Cathy, Lanz Hans-Joachim, Antman Elliott M, Braunwald Eugene, Solomon Scott D
机构信息
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
JACC Clin Electrophysiol. 2023 Apr;9(4):569-580. doi: 10.1016/j.jacep.2022.11.032. Epub 2023 Feb 22.
BACKGROUND
The risks of heart failure (HF) events compared with stroke/systemic embolic events (SEE) or major bleeding (MB) in heart failure with reduced ejection fraction (HFrEF) vs heart failure with preserved ejection fraction (HFpEF) in a large atrial fibrillation (AF) population have not been well-studied.
OBJECTIVES
This study sought to assess HF outcomes, according to HF history and HF phenotypes (HFrEF vs HFpEF), and compare these events with SEE and MB, among patients with AF.
METHODS
We analyzed patients enrolled in the ENGAGE-AF TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in AF-Thrombolysis in Myocardial Infarction 48) trial. Cumulative incidence of heart failure hospitalization (HHF) or HF death was assessed and compared with the rates of fatal and nonfatal stroke/SEE and MB over a median follow-up of 2.8 years.
RESULTS
Overall, 12,124 (57.4%) had a history of HF (37.7% HFrEF, 40.1% HFpEF, 22.1% with unknown ejection fraction). The rate per 100 person-years (py) of HHF or HF death (4.95; 95% CI: 4.70-5.20) was higher than of fatal and nonfatal stroke/SEE (1.77; 95% CI: 1.63-1.92) and MB (2.66; 95% CI: 2.47-2.86) among patients with HF history. HFrEF patients experienced a higher rate of HHF or HF death compared with HFpEF patients (7.15 vs 3.65; P < 0.001), while the rates of fatal and nonfatal stroke/SEE and MB were similar by HF phenotype. Patients with HF history had a higher rate of mortality after a HHF (1.29; 95% CI: 1.17-1.42) than after a stroke/SEE (0.69; 95% CI: 0.60-0.78) or after MB (0.61; 95% CI: 0.53-0.70). Overall, patients with nonparoxysmal AF had a higher rate of HF and stroke/SEE events regardless of HF history.
CONCLUSIONS
Patients with AF and HF, regardless of ejection fraction, are at a higher risk of HF events with higher subsequent mortality rates than of stroke/SEE or MB. While HFrEF is associated with a higher risk of HF events than HFpEF, the risk of stroke/SEE and MB is similar between HFrEF and HFpEF.
背景
在大量心房颤动（AF）人群中，射血分数降低的心力衰竭（HFrEF）与射血分数保留的心力衰竭（HFpEF）相比，发生心力衰竭（HF）事件的风险与中风/全身性栓塞事件（SEE）或大出血（MB）的风险尚未得到充分研究。
目的
本研究旨在根据HF病史和HF表型（HFrEF与HFpEF）评估AF患者的HF结局，并将这些事件与SEE和MB进行比较。
方法
我们分析了参与ENGAGE-AF TIMI 48（房颤患者使用新一代Xa因子有效抗凝-心肌梗死溶栓48）试验的患者。评估心力衰竭住院（HHF）或HF死亡的累积发生率，并与中位随访2.8年期间的致命性和非致命性中风/SEE以及MB的发生率进行比较。
结果
总体而言，12124例（57.4%）有HF病史（37.7%为HFrEF，40.1%为HFpEF，22.1%射血分数未知）。有HF病史的患者中，每100人年（py）的HHF或HF死亡发生率（4.95；95%CI：4.70-5.20）高于致命性和非致命性中风/SEE（1.77；95%CI：1.63-1.92）以及MB（2.66；95%CI：2.47-2.86）。与HFpEF患者相比，HFrEF患者经历HHF或HF死亡的发生率更高（7.15对3.65；P<0.001），而按HF表型分类的致命性和非致命性中风/SEE以及MB的发生率相似。有HF病史的患者在HHF后的死亡率（1.29；95%CI：1.17-1.42）高于中风/SEE后（0.69；95%CI：0.60-0.78）或MB后（0.61；95%CI：0.53-0.70）。总体而言，无论有无HF病史，非阵发性AF患者发生HF和中风/SEE事件的数据更高。
结论
AF和HF患者，无论射血分数如何，发生HF事件的风险更高，随后的死亡率也高于中风/SEE或MB。虽然HFrEF与HF事件的风险高于HFpEF相关，但HFrEF和HFpEF之间的中风/SEE和MB风险相似。
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