射血分数降低的心力衰竭患者左心房功能指标与新发心房颤动风险

Measures of left atrial function and risk of incident atrial fibrillation in patients with heart failure with reduced ejection fraction.

作者信息

Stanchev Anton, Christensen Jacob, Davidovski Filip Soeskov, Espersen Caroline, Sengeløv Morten, Johnsen Cecilie, Özbek B Tas, Jørgensen Peter Godsk, Pareek Manan, Bruun Niels Eske, Fritz-Hansen Thomas, Biering-Sørensen Tor

机构信息

Center for Translational Cardiology and Pragmatic Randomized Trials (CTCPR), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Gentofte Hospitalsvej 8, 2900 Hellerup, Denmark.

Department of Cardiology, Cardiovascular Non-Invasive Imaging Research Laboratory, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Gentofte Hospitalsvej 8, 2900 Hellerup, Denmark.

出版信息

Eur Heart J Cardiovasc Imaging. 2025 Aug 29;26(9):1549-1556. doi: 10.1093/ehjci/jeaf205.

DOI:10.1093/ehjci/jeaf205

PMID:40673369

Abstract

AIMS

Measures of left atrial (LA) function have demonstrated prognostic value in relation to incident atrial fibrillation. This study aimed to investigate the relationship between measures of LA function and the risk of incident atrial fibrillation (AF) in outpatients with HFrEF.

METHODS AND RESULTS

Subjects were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Measures included LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS). Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms. The final study population consisted of 452 subjects (mean age 65.5 ± 11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI: 1.02-1.04, P = 0.009, PALS: HR 1.06 per 1% decrease, 95% CI: 1.04-1.09, P = 0.037, PACS: HR 1.07 per 1% decrease, 95% CI: 1.03-1.10, P = 0.021). The prognostic value of LAEF was modified by sex and valve disease (P for interaction = 0.007 and 0.041, respectively), while the value of PACS was modified by valve disease (P for interaction = 0.011).

CONCLUSION

Impaired PALS, LAEF, and PACS were all associated with an increased risk of incident AF in outpatients with HFrEF.

摘要

目的

左心房（LA）功能指标已显示出与房颤发生相关的预后价值。本研究旨在探讨LA功能指标与射血分数降低的心力衰竭（HFrEF）门诊患者发生房颤（AF）风险之间的关系。

方法和结果

回顾性纳入一家心力衰竭诊所的受试者，并使用丹麦国家患者登记处进行随访。测量指标包括左心房排空分数（LAEF）、心房纵向峰值应变（PALS）和心房收缩峰值应变（PACS）。采用Cox比例风险回归评估预后价值。使用交互项评估性别、瓣膜疾病和左心房扩大对效应的修正作用。最终研究人群包括452名在基线时无房颤的受试者（平均年龄65.5±11.8岁，男性占70.1%）。在中位随访9.4年[四分位间距：5.2，12.7]期间，118名（26.1%）患者发生了房颤。这些受试者的左心房容积指数（LAVi）较高，而LAEF、PALS和PACS均显著较低。在单变量和校正Cox回归分析中，LA功能的所有三项测量指标均与房颤发生显著相关（校正分析：LAEF：每降低1%，风险比[HR]为1.03，95%置信区间[CI]：1.02 - 1.04，P = 0.009；PALS：每降低1%，HR为1.06，95%CI：1.04 - 1.09，P = 0.037；PACS：每降低1%，HR为1.07，95%CI：1.03 - 1.10，P = 0.021）。LAEF的预后价值受性别和瓣膜疾病的修正（交互作用P值分别为0.007和0.041），而PACS的价值受瓣膜疾病的修正（交互作用P值为0.011）。