National Taiwan University College of Medicine, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
Heart Rhythm. 2024 Sep;21(9):1500-1506. doi: 10.1016/j.hrthm.2024.02.048. Epub 2024 Feb 27.
Congestive heart failure (CHF) as a risk of stroke in patients with atrial fibrillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable.
The study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies.
In a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHADS-VASc score, further using Cox models adjusted for risk factors of AF-related stroke.
Patients with HFpEF and HFmrEF had a higher mean CHADS-VASc score compared with patients with HFrEF (4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712; P < .001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161-1.688; P < .001] for HFmrEF; HR, 1.184 [1.075-1.303; P = .001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHADS-VASc score (0-4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189-2.068; P = .001]; HFmrEF HR, 1.890 [1.372-2.603; P < .001]; HFpEF HR, 1.800 [1.526-2.123; P < .001] vs no CHF).
After multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHADS-VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke.
充血性心力衰竭（CHF）是心房颤动（AF）患者发生中风的一个风险因素，主要是指左心室收缩功能障碍的患者。是否应将射血分数保留的心力衰竭（HFpEF）患者包括在内，这是有争议的。
本研究旨在探讨射血分数保留的心力衰竭（HFpEF）、射血分数中间范围的心力衰竭（HFmrEF）和射血分数降低的心力衰竭（HFrEF）的 AF 患者中风风险的变化，以增强风险评估和随后的管理策略。
在一项使用台湾大学医院综合医疗数据库的纵向研究中，观察了 8358 名 AF 患者 10 年（平均随访 3.76 年）。研究评估了不同射血分数和 CHADS-VASc 评分的患者发生缺血性中风的风险，并进一步使用 Cox 模型调整了与 AF 相关的中风风险因素。
与 HFrEF 患者相比，HFpEF 和 HFmrEF 患者的平均 CHADS-VASc 评分更高（4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712；P <.001），且随访期间中风风险更高（HFmrEF 的风险比[HR]为 1.40 [1.161-1.688；P <.001]；HFpEF 的 HR 为 1.184 [1.075-1.303；P =.001] 与无 CHF 相比），多变量调整后）。在 CHADS-VASc 评分较低（0-4）的患者中，任何类型的 CHF 都会增加缺血性中风的风险（HFrEF HR，1.568 [1.189-2.068；P =.001]；HFmrEF HR，1.890 [1.372-2.603；P <.001]；HFpEF HR，1.800 [1.526-2.123；P <.001] 与无 CHF 相比）。
多变量调整后，HFpEF 和 HFmrEF 显示 AF 患者中风风险相似。因此，将 CHADS-VASc 评分中的 C 标准扩展到包括 HFpEF 和 HFmrEF 患者是很重要的。在伴有较少中风危险因素的患者中，任何类型的 CHF 都会增加缺血性中风的风险。
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