Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction: A meta‐analysis

BackgroundCatheter ablation (CA) is an effective treatment for patients with atrial fibrillation (AF). The potential of CA to benefit AF patients with heart failure and preserved ejection fraction (HFpEF) is uncertain.HypothesisCA may be safe and effective for patients with HFpEF.MethodsThe Medline, PubMed, Embase, and Cochrane Library databases were searched for studies evaluating CA for AF patients with HFpEF.ResultsA total of seven trials with 1696 patients were included. Pooled analyses demonstrated similar procedure and fluoroscopy time regarding the use of CA for patients with HFpEF and without HF (weighted mean difference [WMD]: 0.40; 95% confidence interval (CI): −0.01–0.81, p = .05 and [WMD: 0.05; 95% CI: −0.18–0.28, p = .68]). Moreover, CA was effective in maintaining sinus rhythm (SR) in patients with HFpEF and noninferior for patients without HF [risk ratio (RR): 0.92; 95% CI: 0.76–1.10, p = .34). Additionally, CA tended to significantly maintain SR (RR: 4.73; 95% CI: 1.86–12.03, p = .001) and reduce rehospitalization for HF compared with medical therapy (RR: 0.36; 95% CI: 0.19–0.71, p = .003). However, no significant differences were found between two groups regarding the mortality rate (p = .59).ConclusionCA is a potential treatment strategy for patients with HFpEF and demonstrates equivalent efficacy to that of patients without HF. Moreover, the benefits of CA in maintaining SR and reducing rehospitalization of HF patients were significantly better than those of medical therapy. Additional randomized controlled trials are warranted to confirm our results.     

左西孟旦治疗射血分数正常充血性心力衰竭患者的短期疗效

目的：探讨左西孟旦治疗射血分数正常充血性心力衰竭（HFnEF）患者的短期疗效. 方法：入选HFnEF患者80例,随机分为常规治疗组（血管紧张素转换酶抑制剂/血管紧张素受体阻断剂＋利尿剂＋硝酸酯类扩血管药）和左西孟旦组（常规治疗的基础上加用左西孟旦）,每组各40例.所有患者于入院时和用药7d后测定N末端B型利钠肽原（NT-proBNP）血浆水平、心功能分级、静息及分级小剂量多巴酚丁胺负荷后左室收缩功能指标：左室射血分数（LVEF）、高峰射血率（PER）、高峰射血时间（TPER）,并计算其最大变化率. 结果：治疗后两组NT-proBNP血浆水平均较治疗前明显下降,左西孟旦组治疗后NT-proBNP血浆水平低于常规治疗组治疗后（P＜0.05）;左西孟旦组显效率和总有效率高于常规治疗组,无效率低于常规治疗组（P＜0.05）;左西孟旦组治疗后LVEF、PER及TPER的最大变化率均较治疗前明显增加,且左西孟旦组治疗后LVEF的最大变化率明显高于常规治疗组（P＜0.05）. 结论：左西孟旦对HFnEF患者短期疗效良好,能降低患者血浆NT-proBNP水平,改善左心室收缩功能.     

Therapeutic interventions for heart failure with preserved ejection fraction:A summary of current evidence

Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.     

Long‐term outcome of hypertensive patients with heart failure with mid‐range ejection fraction: The significance of blood pressure control

Heart failure (HF) with mid‐range ejection fraction (HFmrEF) is a newly suggested entity in HF. Since it has been inadequately addressed, there is an urgent need to determine the profile of HFmrEF patients and the optimal approach to their management. The present study aimed to assess the long‐term clinical outcomes of hypertensive patients with HFmrEF and the impact of blood pressure (BP) on their mortality and cardiovascular outcome. We performed a retrospective observational study that included 121 hypertensive patients with HFmrEF and 149 hypertensives with heart failure and preserved ejection fraction (HFpEF). The median follow‐up was 84 months (22‐122). Our analysis did not reveal any statistically significant difference between the two groups in total mortality (P = 0.34) or cardiovascular mortality (P = 0.54). The total mean survival time was 102.9 months (100.5‐110.1), while the mean survival time was 105.3 months (80.4‐90.2) in HFpEF and 97.6 months (92.7‐102.6) in HFmrEF. An office systolic BP > 139 mm Hg and diastolic BP > 89 mm Hg were significantly associated with both all‐cause mortality (P = 0.02 and P = 0.013, respectively) and cardiovascular mortality (P = 0.02 for both). In HFpEF patients, no significant association was found between outcome and office BP. HFpEF and HFmrEF have similar long‐term outcomes. Suboptimal BP levels are a significant risk factor for an adverse outcome in HFmrEF. Our results emphasize the importance of good BP control in order to achieve better outcomes in hypertensives with impaired EF and HF symptomatology.     

左室射血分数保留的心力衰竭研究进展

心力衰竭是各种临床心血管疾病发展的终末阶段,高发生率及高病死率使其受到越来越多的关注。在美国,其总体发生率约为1.5%～2.0%,而在年龄≥65岁的人群当中,则高达6%～10%[1]。中国的一项随机调查研究选取了15518位成年人(年龄     

射血分数正常的充血性心力衰竭患者收缩功能储备的研究

目的:探讨射血分数正常的充血性心力衰竭(HFnEF)患者左室收缩功能的储备情况。方法:入选HFnEF患者40例,将同期40例经临床和超声心动图排除心力衰竭者设为对照组,所有入选对象行超声心动图检查、核素心血池显像测定静息及分级小剂量多巴酚丁胺负荷后心率(HR)、左室射血分数(LVEF)、高峰射血率(PER)、高峰射血时间(TPER),并计算各指标的最大变化率(ΔHR、ΔLVEF、ΔPER、ΔTPER)。结果:与对照组相比,HFnEF组左房内径、左室收缩期末内径、左室舒张期末内径明显增大,室间隔厚度、左室后壁厚度均显著增加(P<0.05);HFnEF组ΔHR、ΔLVEF、ΔPER、ΔTPER均较对照组降低,分别为54.8%±13.5%对78.8%±15.1%、29.9%±8.2%对40.7%±5.7%、83.0%±28.8%对124.5%±40.3%和46.3%±10.5%对57.3%±8.1%(P均<0.05)。结论:HFnEF患者左室收缩功能储备明显下降。     

重组人脑钠肽对射血分数正常心力衰竭患者脑钠肽前体的影响

目的探讨经重组人脑钠肽(recombinant human brain natriuretic peptide,rhBNP)治疗后,射血分数正常心力衰竭(heart failure with normal ejection fraction,HFNEF)患者的血浆脑钠肽前体(pro-brain natriuretic peptide,proBNP)浓度及临床症状的变化。方法入选51例HFNEF患者(纽约心脏协会心功能Ⅲ、Ⅳ级),其中21例在常规治疗的基础上加用rhBNP治疗4～7 d,治疗前、后分别检测血浆proBNP浓度,并与仅用常规治疗的对照组(30例)比较。分析治疗前、后血浆proBNP浓度及临床症状变化。结果治疗组与对照组总有效率分别为95.2%和93.3%,差异无统计学意义(P>0.05)。两组治疗后血浆proBNP浓度与治疗前比较都有下降,差异有统计学意义(P<0.05);且治疗组治疗后血浆proBNP浓度显著低于与对照组,差异有统计学意义[1 297.5 pg/mL vs.2 037.8 pg/mL,P<0.05]。结论rhBNP可降低HFNEF患者血浆proBNP浓度,有效改善患者症状。