Heart:心房颤动不是主动脉瓣狭窄患者预后的预测因素

2019-08-24 xing.T MedSci原创

由此可见,AF与严重AS患者的预后不良相关,但与SR相比,结局的显著差异可由AF以外的因素所解释,包括伴随的心脏异常和由于心脏症状归因于AF导致的AVR延迟。

近日,心脏病领域权威杂志Heart上发表了一篇研究文章,该研究旨在评估心房颤动(AF)与窦性心律(SR)对严重主动脉瓣狭窄(AS)患者的治疗和结局的意义。

研究人员确定了1847例连续就诊的重度AS患者(主动脉瓣面积小于1.0cm2,主动脉瓣收缩期平均多普勒梯度超过40mmHg或峰值速度超过4m/s)和左心室射血分数大于50%的患者。研究人员评估了AF与全因死亡率的独立关联。

参与者年龄为76±11岁,女性占46%;293例(16%)患者有AF,1554例(84%)为SR。在AF患者中,72%是有症状的,而SR参与者中为71%。AF患者(41%)5年生存率低于SR(65%)(年龄和性别调整HR=1.66(1.40-1.98),p<0.0001)。在多变量分析中,与死亡率相关的因素包括年龄(每十岁的HR=1.55(1.42-1.69),p<0.0001)、呼吸困难(HR=1.58(1.33-1.87),p<0.0001)、中度二尖瓣关闭不全(HR=1.63(1.22-2.18),p=0.001)、右心室收缩功能不全(HR=1.88(1.52-2.33),p<0.0001)、左心房容积指数(10 mL/m2的HR=1.13(1.07-1.19),p<0.0001)和主动脉瓣膜置换术(AVR)(HR=0.44(0.38-0.52),p<0.0001)。AF不是死亡率的预测因子,与强相关的变量无关,(HR=1.02(0.84-1.25),p=0.81)。AF诊断后严重AS的1年AVR几率(49.8%)低于SR(62.5%)(HR=0.73(0.62-0.86),p<0.001); 在未转诊为AVR的AF患者中,症状通常归因于AF而非AS。

由此可见,AF与严重AS患者的预后不良相关,但与SR相比,结局的显著差异可由AF以外的因素所解释,包括伴随的心脏异常和由于心脏症状归因于AF导致的AVR延迟。 

原始出处:

Hongju Zhang.et al.Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis.Heart.2019.http://dx.doi.org/10.1136/heartjnl-2019-314996

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    2019-08-26 zhaojie88
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    2019-08-26 sodoo

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