心房颤动负担和心房分流治疗射血分数保留的心力衰竭。
Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction.
机构信息
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, USA.
Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
JACC Heart Fail. 2023 Oct;11(10):1351-1362. doi: 10.1016/j.jchf.2023.05.024. Epub 2023 Jul 19.
BACKGROUND
Atrial fibrillation (AF) is a common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and in heart failure with mildly reduced ejection fraction (HFmrEF).
OBJECTIVES
This study sought to describe AF burden and its clinical impact among individuals with HFpEF and HFmrEF who participated in a randomized clinical trial of atrial shunt therapy (REDUCE LAP-HF II [A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]) and to evaluate the effect of atrial shunt therapy on AF burden.
METHODS
Study investigators characterized AF burden among patients in the REDUCE LAP-HF II trial by using ambulatory cardiac patch monitoring at baseline (median patch wear time, 6 days) and over a 12-month follow-up (median patch wear time, 125 days). The investigators determined the association of baseline AF burden with long-term clinical events and examined the effect of atrial shunt therapy on AF burden over time.
RESULTS
Among 367 patients with cardiac monitoring data at baseline and follow-up, 194 (53%) had a history of AF or atrial flutter (AFL), and median baseline AF burden was 0.012% (IQR: 0%-1.3%). After multivariable adjustment, baseline AF burden ≥0.012% was significantly associated with heart failure (HF) events (HR: 2.00; 95% CI: 1.17-3.44; P = 0.01) both with and without a history of AF or AFL (P for interaction = 0.68). Adjustment for left atrial reservoir strain attenuated the baseline AF burden-HF event association (HR: 1.71; 95% CI: 0.93-3.14; P = 0.08). Of the 367 patients, 141 (38%) had patch-detected AF during follow-up without a history of AF or AFL. Atrial shunt therapy did not change AF incidence or burden during follow-up.
CONCLUSIONS
In HFpEF and HFmrEF, nearly 40% of patients have subclinical AF by 1 year. Baseline AF burden, even at low levels, is associated with HF events. Atrial shunt therapy does not affect AF incidence or burden. (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure [REDUCE LAP-HF II]; NCT03088033).
背景
心房颤动（AF）是射血分数保留型心力衰竭（HFpEF）和射血分数轻度降低型心力衰竭（HFmrEF）患者的常见合并症。
目的
本研究旨在描述接受心房分流治疗（REDUCE LAP-HF II [评估 Corvia Medical, Inc IASD 系统 II 以降低心力衰竭患者左心房压力的研究]）的 HFpEF 和 HFmrEF 患者的 AF 负担及其临床影响，并评估心房分流治疗对 AF 负担的影响。
方法
研究人员通过在基线（中位贴片佩戴时间为 6 天）和 12 个月随访（中位贴片佩戴时间为 125 天）期间使用动态心脏贴片监测，对 REDUCE LAP-HF II 试验中的患者的 AF 负担进行了描述。研究人员确定了基线 AF 负担与长期临床事件之间的关联，并检查了心房分流治疗对 AF 负担随时间的影响。
结果
在基线和随访时有心脏监测数据的 367 名患者中，194 名（53%）有 AF 或心房扑动（AFL）病史，中位基线 AF 负担为 0.012%（IQR：0%-1.3%）。经过多变量调整后，基线 AF 负担≥0.012%与心力衰竭（HF）事件显著相关（HR：2.00；95%CI：1.17-3.44；P=0.01），且无论是否有 AF 或 AFL 病史（P 交互=0.68）。左心房储备应变的调整减弱了基线 AF 负担与 HF 事件的关联（HR：1.71；95%CI：0.93-3.14；P=0.08）。在 367 名患者中，有 141 名（38%）在没有 AF 或 AFL 病史的情况下在随访期间出现了贴片检测到的 AF。心房分流治疗并未改变随访期间的 AF 发生率或负担。
结论
在 HFpEF 和 HFmrEF 中，近 40%的患者在 1 年内出现亚临床 AF。即使在低水平，基线 AF 负担也与 HF 事件相关。心房分流治疗不会影响 AF 的发生率或负担。（评估 Corvia Medical, Inc IASD 系统 II 以降低心力衰竭患者左心房压力的研究 [REDUCE LAP-HF II]；NCT03088033）。
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