心房颤动对慢性收缩性心力衰竭患者和射血分数正常心力衰竭患者预后的影响

目的 探讨心房颤动（简称房颤）对慢性收缩性心力衰竭（CSHF）及慢性射血分数正常心力衰竭（HF-PSF）住院患者预后的影响。方法 前瞻性分析武汉地区4家三级甲等教学医院848例心力衰竭（简称心衰）患者,根据左室射血分数分为CSHF组（n=560）、HFPSF组（n=288）。 每组根据有无房颤又分为房颤与非房颤亚组。 单因素Kaplan-Meier曲线分别分析CSHF和HFPSF患者房颤亚组和非房颤亚组总死亡 、 心脏泵功能衰竭死亡（心衰死亡）、 心源性猝死和栓塞相关死亡的差异 。多因素Cox风险比例模型分别比较CSHF和HFPSF患者房颤亚组与非房颤亚组不同预后的差异。 结果 单因素分析发现, CSHF和HFPSF组房颤亚组与非房颤亚组总死亡无差异。CSHF组中与非房颤亚组（n=374）相比,房颤亚组（n = 186）心衰死亡增高（P = 0. 01）、栓塞相关死亡增加（P0.05）。 多因素Cox风险比例模型分析发现房颤增加CSHF患者栓塞相关死亡风险（HR = 2. 106,95% CI：1. 436 - 2.719,P〈0. 01）。 结论 房颤对CSHF和HFPSF患者预后的影响存在差异,仅增加CSHF患者栓塞相关死亡风险。房颤影响CSHF患者预后的原因可能不在于心律失常本身而在于其并发症。

The prognostic value of atrial fibrillation in patients with chronic systofic heart failure or heart failure with preserved systolic function.

Objective To investigate the prognostic value of atrial fibrillation （AF） in patients with chronic systolic heart failure （CSHF） or heart failure with preserved systolic function （HFPSF）. Methods Data of 848 in-hospital patients with CSHF or HFPSF were collected prospectively between 2008 and 2009 from 4 hospitals in Wuhan City, Hubei Province. Univariate Kaplan-Meier curve was performed to evaluate the difference in prognosis between AF and non-AF group for patients with CSHF or HFPSF, respectively. Multivariate Cox proportional hazard analysis was performed to determinate the risk of all-cause mortality, heart failure （HF） mortality, sudden cardiac death （SCD） and thrombosis-related mortality, respectively, in AF group compared with patients in non-AF group. Results There was no significant difference in all- cause mortality between AF and non-AF sub-groups in both CSHF and HFPSF groups. In CSHF group, AF increase HF mortality and thrombosis-related mortality. In HFPSF group, AF didn＇t affect HF mortality, SCD or thrombosis-related mortality. Multivariate Cox proportional hazard analysis showed AF only increased thrombosis-related mortality in patients with CSHF （HR= 2. 106,95% CI： 1. 436-2. 719,P〈0.01 ） but had no significant effect on other end-points in CSHF or HFPSF groups. Conclusions The prognostic value of AF for patients with CSHF or HFPSF is not consistent. AF only increases thrombosis-related mortality in patients with CSHF.