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在计算CHA₂DS₂-VASc分数时,应包括HFpEF和HFmrEF:台湾纵向队列

Chien-Chien Cheng¹, Pang-Shuo Huang², Jien-Jiun Chen³

¹National Taiwan University College of Medicine, Taipei, Taiwan.

|February 29, 2024

概括

充血性心力衰竭 (CHF) 在心房动 (AF) 患者中增加了中风风险. 这项研究发现,心力衰竭与保留射出分数 (HFpEF) 和中等射出分数 (HFmrEF) 也会增加中风风险,这表明扩大了CHA2DS2-VASc标准.

科学领域:

心脏病学心脏病学
神经学神经学
公共卫生公共卫生

背景情况:

充血性心力衰竭 (CHF) 是心房动 (AF) 患者中已知的中风风险因素,主要与左心室缩功能障碍有关.
在这种风险评估中,将被保存的喷射分数患者纳入这一风险评估仍然是争论的主题.

研究的目的:

为了研究AF心力衰竭患者中脑卒中风险的变化,根据射出分数分类:保存 (HFpEF),中等范围 (HFmrEF) 和减少 (HFrEF).
加强风险评估和管理策略,以不同类型的心力衰竭的AF患者.

主要方法:

一项为期10年的纵向研究,对8358名来自国家台湾大学医院综合医疗数据库的AF患者进行了长期研究.
使用考克斯模型评估缺血性中风风险,根据中风风险因素进行调整,跨越不同的喷射分数和CHA2DS2-VASc得分.

主要成果:

与HFpEF和HFmrEF患者相比,HFpEF和HFmrEF患者的平均CHA2DS2-VASc得分较高,中风风险增加.
在多变量调整后,HFmrEF (HR, 1.40) 和HFpEF (HR, 1.184) 显示出明显高于没有CHF的中风风险.
在较低CHA2DS2-VASc分数 (0-4) 的患者中,所有CHF亚型 (HFrEF,HFmrEF,HFpEF) 都显著增加了缺血性中风风险.

结论:

在AF患者中,HFpEF和HFmrEF存在类似的中风风险,与HFrEF相似.
建议将CHA2DS2-VASc评分标准扩展到包括HFpEF和HFmrEF患者.
强调任何形式的慢性心力衰竭都会增加缺血性中风的风险,特别是在具有较少额外风险因素的患者中.

关键词:

心房动是一种心房动.在CHA(2)DS(2)-VASc分数中获得分数.在HFmrEFEF中使用.HFpEF HFpEF 的意思是什么这就是HFrEFEF.缺血性中风是因为缺血性中风.

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