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La fibrilación auricular provoca insuficiencia cardíaca y viceversa: asociaciones temporales y diferencias en la

Rajalakshmi Santhanakrishnan¹, Na Wang¹, Martin G Larson¹

¹From Cardiovascular Medicine Section, Department of Medicine (R.S., J.W.M., R.S.V., E.J.B.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; Data Coordinating Center (N.W.) and Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (M.G.L., J.W.M., S.C., R.S.V., D.L., E.J.B., J.E.H.); Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Boston (D.D.M., E.J.B.); Cardiology Division (S.A.L., P.T.E., J.E.H.) and Cardiovascular Research Center (S.A.L., P.T.E., J.E.H.), Massachusetts General Hospital, Harvard Medical School, Boston; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (S.A.L., P.T.E.); Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.); Institute for Clinical Evaluative Sciences and Toronto General Hospital, University of Toronto, ON, Canada (D.S.L.); Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.).

|January 10, 2016

Resumen

La fibrilación auricular (FA) y la insuficiencia cardíaca (IH) frecuentemente coexisten. Este estudio encontró que la FA está más fuertemente relacionada con la HF con fracción de eyección preservada, y ambas condiciones juntas aumentan el riesgo de mortalidad, especialmente en la HF con fracción de eyección reducida.

Área de la Ciencia:

Cardiología
Investigación clínica
Epidemiología

Sus antecedentes:

La fibrilación auricular (FA) y la insuficiencia cardíaca (IH) a menudo coexisten, lo que lleva a un mal pronóstico.
La relación entre el AF y los subtipos específicos de HF (fracción de eyección preservada frente a reducida) requiere una aclaración adicional.

Objetivo del estudio:

Investigar la asociación temporal entre AF y HF, examinando específicamente las diferencias en HF con fracción de eyección preservada (HFpEF) frente a HF con fracción de eyección reducida (HFrEF).

Principales métodos:

Análisis de los participantes del Estudio del Corazón de Framingham diagnosticados con AF o HF de nueva aparición entre 1980 y 2012.
Para evaluar las asociaciones se utilizaron ratios de riesgo ajustados por multivariables (RH) e intervalos de confianza (IC).

Principales resultados:

Entre los individuos con nueva FA, el 37% tenía HF; entre los que tenían nueva HF, el 57% tenía AF.
La prevalencia de FA mostró una asociación más fuerte con el HFpEF incidente (HR, 2.34) que con el HFrEF (HR, 1.32).
La combinación de FA e HF aumentó el riesgo de mortalidad, particularmente en pacientes con HFrEF con FA prevalente (HR, 2.72) en comparación con pacientes con HFpEF con FA prevalente (HR, 1.83).

Conclusiones:

La FA es muy frecuente en pacientes con HF, y la HF es común en pacientes con FA.
AF precede y sigue a HFpEF y HFrEF, con distintas asociaciones temporales e implicaciones pronósticas.
Es necesaria una mayor investigación sobre los mecanismos subyacentes a la ocurrencia simultánea de FA e HF.

Palabras clave:

Fibrilación auricular Ciencias de la salud insuficiencia cardíaca la mortalidad Función ventricular izquierda

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