在HFmrEF/HFpEF中的心率和心房动/动:在五项随机临床试验中进行的参与者级别分析
Alberto Foà1,2, Henri Lu1,3, Muthiah Vaduganathan1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
European journal of heart failure
|March 2, 2026
概括
在心力衰竭患者中,心率升高预测只有在鼻节律中更糟糕的结果,而不是在心房动/动 (AFF) 中. 需要进一步研究HFpEF中的AFF管理.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭研究研究
- 临床试验 临床试验
背景情况:
- 心率升高是心力衰竭 (HF) 的已知风险标志物.
- 在患有并发性心房动/心房动 (AFF) 的HF患者心率的预后意义不太清楚.
- 具有中等范围和保存的喷射分数 (HFmrEF/HFpEF) 的HF代表具有独特风险概况的不同患者群体.
研究的目的:
- 调查HFmrEF/HFpEF患者的基线心率和临床结果之间的关联.
- 为了确定这种关联是否不同,基于基线心电图上心房动/动 (AFF) 的存在或不存在.
- 分析来自多项大型临床试验的数据,以获得可靠的研究结果.
主要方法:
- 这是对五项主要HFmrEF/HFpEF试验 (CHARM-Preserved,I-PRESERVE,TOPCAT-Americas,PARAGON-HF,DELIVER) 的参与者级数据的综合分析.
- 多变量Cox和Poisson回归模型被用于评估基线心率和结果之间的关联.
- 主要结局是心血管死亡或HF住院的复合结果,按AFF状态分层.
主要成果:
- 在19,975名参与者中,29%的人有AFF. 患有AFF的患者年龄较大,更常见的是男性,并且基线心率较高 (75比68bpm).
- 观察到一个显著的相互作用:心率的增加与鼻节律中较高的事件率相关,但在AFF中没有.
- 主要结局 (CV死亡或HF住院) 仅在鼻腔节律患者中与较高的基线心率相关 (adj HR 1.19 [1.10-1.27]对于AFF与SR).
结论:
- 基线心率是HFmrEF/HFpEF患有鼻节律的患者不良结果的显著预测因素.
- 在心房动/心房动 (AFF) 患者中没有观察到这种关联.
- 在HFmrEF/HFpEF中对AFF的最佳管理策略需要专门的调查.
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