房内传导阻滞作为射血分数保留的心力衰竭患者不良结局的预测指标。
Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF.
作者信息
Weerts Jerremy, Mourmans Sanne G J, Lopez-Martinez Helena, Domingo Mar, Aizpurua Arantxa Barandiarán, Henkens Michiel T H M, Achten Anouk, Lupón Josep, Rocca Hans-Peter Brunner-La, Knackstedt Christian, Bayés-Genís Antoni, van Empel Vanessa P M
机构信息
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
出版信息
ESC Heart Fail. 2025 Jun;12(3):2287-2297. doi: 10.1002/ehf2.15179. Epub 2024 Dec 1.
AIMS
Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings.
METHODS AND RESULTS
To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEF, (ii) HFpEF, or (iii) HFpEF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEF, 114 (31%) HFpEF and 241 (65%) HFpEF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEF, 12 (11%) HFpEF [HR 4.1 (95% CI 0.5-522.6)] and 59 (24%) HFpEF patients [HR 10.1 (95% CI 1.5-1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEF, 31 (42%) HFpEF (HR 1.5 [95% CI 0.7-3.1]) and 22 (79%) HFpEF (HR 3.8 [95% CI 1.8-8.1], P < 0.001).
CONCLUSIONS
Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.
目的
房内传导阻滞（IAB）是心房电功能障碍的一个标志物，在不同人群中与心房颤动（AF）风险增加及不良事件相关。IAB在射血分数保留的心力衰竭（HFpEF）中的预后影响尚不清楚。本研究的目的是确定IAB的患病率以及IAB和AF与不同医疗环境下HFpEF患者不良事件的关联。
方法与结果
为识别心房电功能障碍，对门诊环境及近期因HF住院后的HFpEF患者的基线心电图和病史进行分析。患者被分为（i）HFpEF，（ii）HFpEF，或（iii）HFpEF。不良事件包括HF住院、心源性/心源性猝死以及两者的复合事件。门诊队列包括372例患者[平均年龄75±7岁，252例（68%）为女性]。近期住院队列包括132例患者[平均年龄81±10岁，80例（61%）为女性]。门诊患者中包括17例（4%）HFpEF、114例（31%）HFpEF和241例（65%）HFpEF，而近期住院患者分别包括31例（23%）、73例（55%）和28例（21%）。对门诊患者随访33个月后，0例（0%）HFpEF、12例（11%）HFpEF[风险比（HR）4.1（95%置信区间0.5 - 522.6）]和59例（24%）HFpEF患者发生复合终点事件[HR 10.1（95%置信区间1.5 - 1270.4），P < 0.001]。近期住院患者呈现相似趋势，10例（32%）HFpEF、31例（42%）HFpEF（HR 1.5[95%置信区间0.7 - 3.1]）和22例（79%）HFpEF发生复合终点事件（HR 3.8[95%置信区间1.8 - 8.1]，P < 0.001）。
结论
心房电功能障碍的进展阶段似乎是门诊及近期住院的HFpEF患者不良结局的预后标志物。无早期心房电功能障碍的门诊HFpEF患者不良结局风险极低。这类患者是否从较宽松的管理中获益仍有待研究。
Zotero 插件