Department of Critical Care Medicine, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, 2088 Tiaoxi East Road, Wuxing District, Huzhou City, Zhejiang Province, China.
BMC Cardiovasc Disord. 2024 Sep 18;24(1):495. doi: 10.1186/s12872-024-04133-1.
Stroke and thromboembolism (TE) are significant complications in patients with atrial fibrillation (AF) and heart failure (HF). The impact of ejection fraction status on these risks remains unclear. This study aims to compare the risk of stroke and TE in patients with AF and HF with preserved (HFpEF) or reduced (HFrEF) ejection fraction.
Literature search of PubMed, Embase, and Scopus databases was done for studies in adult (20 years or more) population of AF patients. Included studies had reported on the incidences of stroke and/or TE in patients with AF and associated HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Cohort (prospective and retrospective), case-control studies, and studies that were based on secondary analysis of data from a trial were eligible for inclusion. Methodological quality was assessed using the Newcastle Ottawa Scale (NOS). Pooled hazard ratio (HR) with 95% confidence intervals (CI) were reported. Exploratory analysis was conducted based on the different cut-offs used to define HFrEF and HFpEF.
Twenty studies were analyzed. In the overall analysis, HFrEF in AF patients was associated with a significantly reduced risk of stroke and systemic TE (HR 0.88, 95% CI: 0.81, 0.96; n = 20, I2 = 86.6%), compared to HFpEF. However, most studies showed comparable risk of stroke among the two groups of patients except for two studies that had documented significantly reduced risk. Upon doing the sensitivity analysis by excluding these two studies, we found similar risk among the two group of subjects and with no heterogeneity (HR 1.01, 95% CI: 0.99, 1.03; n = 18, I2 = 0.0%). Exploratory analysis also showed that the risk of stroke and systemic thromboembolism was similar between those with HFpEF and HFrEF.
The findings suggest that there is no significantly different risk of stroke and systemic thromboembolism in cases of AF with associated HFpEF or HFrEF. The finding does not support integration of left ventricular ejection fraction into stroke risk assessments.
在心房颤动（AF）和心力衰竭（HF）患者中，中风和血栓栓塞（TE）是严重的并发症。射血分数状态对这些风险的影响尚不清楚。本研究旨在比较射血分数保留（HFpEF）或射血分数降低（HFrEF）的 AF 和 HF 患者中风和 TE 的风险。
对 PubMed、Embase 和 Scopus 数据库中的成人（20 岁及以上）AF 患者文献进行检索。纳入的研究报告了 AF 患者并发射血分数降低（HFrEF）和射血分数保留（HFpEF）心力衰竭的中风和/或 TE 发生率。队列（前瞻性和回顾性）、病例对照研究以及基于试验数据二次分析的研究均符合纳入标准。使用纽卡斯尔-渥太华量表（NOS）评估方法学质量。报告了合并的风险比（HR）及其 95%置信区间（CI）。根据不同的截断值定义 HFrEF 和 HFpEF 进行了探索性分析。
分析了 20 项研究。在总体分析中，与 HFpEF 相比，AF 患者的 HFrEF 与中风和系统性 TE 的风险显著降低（HR 0.88，95%CI：0.81，0.96；n=20，I2=86.6%）。然而，除了两项研究记录到风险显著降低外，大多数研究表明两组患者的中风风险相当。在排除这两项研究进行敏感性分析后，我们发现两组受试者的风险相似，且无异质性（HR 1.01，95%CI：0.99，1.03；n=18，I2=0.0%）。探索性分析还表明，HFpEF 和 HFrEF 患者中风和系统性血栓栓塞的风险相似。
这些发现表明，AF 合并 HFpEF 或 HFrEF 患者中风和系统性血栓栓塞的风险没有显著差异。该结果不支持将左心室射血分数纳入中风风险评估。
