射血分数降低、轻度降低及保留的心力衰竭患者的心房颤动：心力衰竭观察性研究（HEROES）报告

Atrial fibrillation in patients with heart failure with reduced, mildly reduced, and preserved ejection fraction: A report from the HEart failuRe ObsErvational Study (HEROES).

作者信息

Gorczyca-Głowacka Iwona, Galas Agata, Tymińska Agata, Byczkowska Katarzyna, Furman-Niedziejko Anna, Tkaczyszyn Michał, Stefański Adrian, Major Agnieszka, Klimczak-Tomaniak Dominika, Hamala Piotr, Zachura Małgorzata, Staciwa Mateusz, Nadel Maciej, Morawiec Robert

机构信息

Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.

Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland.

出版信息

Kardiol Pol. 2025;83(6):701-708. doi: 10.33963/v.phj.105590. Epub 2025 Apr 11.

DOI:10.33963/v.phj.105590

PMID:40214237

Abstract

BACKGROUND

Heart failure (HF) and atrial fibrillation (AF) often coexist and modify each other's course. The prevalence and clinical characteristics of AF differ in specific HF subtypes.

AIMS

The study aimed to evaluate the incidence and clinical features of people with AF in comparison to those with sinus rhythm in HF, across the three HF subtypes categorized by left ventricular ejection fraction (EF).

MATERIAL AND METHODS

Hospitalized patients and outpatients were enrolled in the Heart failuRe ObsErvational Study - a prospective, multicenter cohort study. HF subtypes were defined as reduced EF (HFrEF, EF <40%), mildly reduced EF (HFmrEF, EF 40%-49%), or preserved EF (HFpEF, EF ≥50%).

RESULTS

A total of 1210 patients with HF were included in the study (71.8% male). Among them, 51.8% had HFrEF, 21.7% had HFmrEF, and 26.5% had HFpEF. Within the entire HF study population, 79.5% were hospitalized, and AF was present in 51.8% of patients. The prevalence of AF was 53.9% in HFrEF, 49.7% in HFmrEF, and 51.7% in HFpEF (P = 0.59). The strongest factors independently associated with AF in different HF subtypes were echocardiographic abnormalities: aortic regurgitation in patients with HFpEF (OR, 9.02; CI, 1.14-71.27; P <0.001), left atrial volume > median in patients with HFmrEF (OR, 6.21; CI, 2.24-17.2; P <0.001) and in patients with HFrEF (OR, 3.9; CI, 2.21-6.90; P <0.001). Selected independent associations with AF were similar in the HFpEF, HFmrEF, and HFrEF groups.

CONCLUSIONS

In the population with HF, the AF incidence is similar in the HFrEF, HFmrEF, and HFpEF groups. It is associated with similar clinical characteristics in HF subtypes.

摘要

背景

心力衰竭（HF）和心房颤动（AF）常并存并相互影响病程。AF的患病率和临床特征在特定的HF亚型中有所不同。

目的

本研究旨在评估按左心室射血分数（EF）分类的三种HF亚型中，AF患者与窦性心律患者相比的发病率和临床特征。

材料与方法

将住院患者和门诊患者纳入心力衰竭观察性研究——一项前瞻性、多中心队列研究。HF亚型定义为射血分数降低（HFrEF，EF<40%）、射血分数轻度降低（HFmrEF，EF 40%-49%）或射血分数保留（HFpEF，EF≥50%）。

结果

本研究共纳入1210例HF患者（男性占71.8%）。其中，51.8%为HFrEF，21.7%为HFmrEF，26.5%为HFpEF。在整个HF研究人群中，79.5%为住院患者，51.8%的患者存在AF。AF在HFrEF中的患病率为53.9%，在HFmrEF中为49.7%，在HFpEF中为51.7%（P=0.59）。不同HF亚型中与AF独立相关的最强因素是超声心动图异常：HFpEF患者的主动脉反流（OR，9.02；CI，1.14-71.27；P<0.001），HFmrEF患者左心房容积>中位数（OR，6.21；CI，2.24-17.2；P<0.001）以及HFrEF患者（OR，3.9；CI，2.21-6.90；P<0.001）。在HFpEF、HFmrEF和HFrEF组中，与AF相关的选定独立关联相似。