在心力衰竭中,心房动负担和心房转移疗法与保存的喷射分数
Ravi B Patel1, Vivek Y Reddy2, Jan Komtebedde3
1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, USA.
JACC. Heart failure
|July 22, 2023
概括
即使在较低水平上,心房 (AF) 负担也能预测心力衰竭患者的心力衰竭事件,心力衰竭患者的心力衰竭是保持喷射分数 (HFpEF) 和轻微减少喷射分数 (HFmrEF). 房分流疗法没有影响AF负担或发生率.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭研究研究
背景情况:
- 心房动 (AF) 是诊断为心力衰竭与保存喷射率 (HFpEF) 和心力衰竭与轻微减少喷射率 (HFmrEF) 的患者经常出现的并发症.
- 了解这些特定心力衰竭人群中AF负担的患病率和影响对于临床管理和治疗开发至关重要.
研究的目的:
- 在REDUCE LAP-HF II试验中,描述AF负担并评估其在HFpEF和HFmrEF患者的临床意义.
- 在12个月的随访期内,评估心房分流治疗对AF负担的影响.
主要方法:
- 在367名患者中利用门诊心脏贴片监测来量化在基线 (中位数为6天) 和12个月的随访 (中位数为125天) 时的AF负担.
- 使用多变量分析确定了基线AF负担和长期心力衰竭 (HF) 事件之间的关联.
- 在整个研究期间评估了心房分流治疗对AF发病率和负担的影响.
主要成果:
- 超过50%的患者有AF或心房 (AFL) 的病史;基线AF负担的中位数为0.012%.
- 基线AF负担≥0.012%与HF事件的增加显著相关 (HR:2.00),无论先前的AF/AFL史.
- 在随访期间,大约38%的患者出现了新的,贴片检测到的AF;心房分流治疗没有改变AF发生率或负担.
结论:
- 在一年内,在近40%的HFpEF和HFmrEF患者中检测到亚临床AF,这突显了其流行率.
- 基线AF负担,即使在最低水平,也是这些患者群体中HF事件的显著预测因素.
- 耳前突变疗法对AF发生率或负担没有影响,这表明其主要益处在于其他机制.
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