中性粒细胞/淋巴细胞比值对射血分数保留的心力衰竭患者远期预后的影响

目的：探讨中性粒细胞/淋巴细胞比值（NLR）对射血分数保留的心力衰竭（HFpEF）患者远期预后的影响。方法：回顾性分析2013年1月至2018年12月在中国医科大学附属盛京医院心内科因心力衰竭入院治疗的3 608例HFpEF患者的临床资料，同时根据入院NLR水平分为三组：NLR低值组（NLR≤2.47,n=1 204）、NLR中值组（NLR 2.48～4.12,n=1 203）、NLR高值组（NLR≥4.13,n=1 201）。采用Cox回归及Kaplan-Meier生存曲线分析NLR对HFpEF患者远期预后的影响，同时应用ROC曲线分析NLR评估HFpEF患者全因死亡及心血管死亡的价值。结果：平均随访（3.20±2.01）年期间，NLR低值组、中值组、高值组心血管死亡分别为163例（13.5%）、257例（21.4%）、408例（34.0%），全因死亡分别为273例（22.7%）、403例（33.5%）、617例（51.4%），组间比较差异均有统计学意义（P均<0.001）。多因素Cox回归分析显示，NLR是HFpEF患者预后的危险因素，NLR每增加1，心血管死亡风险增加1.3...     

老年营养风险指数对冠状动脉慢性完全闭塞病变患者经皮冠状动脉介入治疗术后远期预后的预测价值

目的 探讨经皮冠状动脉介入治疗（PCI）老年慢性完全闭塞（CTO）病变患者的营养状态与远期预后的关系。方法 纳入2013年6月至2017年10月于西安交通大学第一附属医院346例行PCI的老年CTO病变患者,根据老年营养风险指数（GNRI）分为3组：无营养不良风险组（GNRI≥98,186例）,营养不良低风险组（92≤GNRI<98,114例）,营养不良中度/高度风险组（GNRI<92,46例）。主要终点事件为全因死亡,次要终点事件为心血管死亡。结果 纳入的346例患者平均年龄为72岁,中位随访33个月,Kaplan-Meier生存分析显示,营养不良中/重度风险患者在全因死亡及心血管死亡方面的预后均比其他两组差（Log-rank检验,全因死亡：P=0.004,心血管死亡：P=0.003）。多因素Cox回归分析提示全因死亡与中/重度营养不良、淋巴细胞计数及左心室射血分数相关,心血管死亡只与中/重度营养不良相关。与无营养不良风险患者相比,营养不良中/重度风险患者全因死亡及心血管死亡风险显著增加（HR 2.580,95%CI 1.139～5.842,P=0.023;HR4.709...     

中国急诊心房颤动患者心血管相关药物的应用和预后分析

目的 探讨心血管相关药物在中国急诊心房颤动(房颤)患者中的应用情况和对临床结局事件的影响。 方法 连续入选 2008 年 11 月至 2011 年 10 月在全国 20 家医院急诊科就诊的房颤患者,收集患者基线资料和心血管用药治疗情况。 根据心血管药物应用数量,将患者分为多重用药(≥5 种心血管药物)组和无多重用药(<5 种心血管药物)组;进行 1 年随访,主要终点事件为全因死亡、心血管死亡和再入院。 应用单因素和多因素logistic 和 Cox 回归模型分析上述事件的独立危险因素。 结果 本研究共入选 2015 例房颤患者,平均心血管药物数量(3. 4±1. 9)种,多重用药患者 570 例(28. 3%)。 与无多重用药患者相比,多重用药患者的体质指数、血压和 CHA₂DS₂-VASc 评分更高,吸烟史、永久性房颤、冠心病、高血压、心力衰竭和糖尿病的比例更高(均为P<0. 05)。 多因素logistic 回归分析显示,舒张压(OR= 1. 013,95%CI:1. 004～1. 023)、阵发性和永久性房颤(OR= 1...     

肺高压与维持性血液透析患者心血管预后的关系

目的 探讨肺高压（pulmonary hypertension,PH）对维持性血液透析（maintenance hemodialysis,MHD）患者全因死亡及心血管并发症的影响.方法 我们于2009年至201 1年期间随访了278例MHD患者（98例PH、180例无PH）,随访终点为死亡和主要心血管事件.PH定义为心脏超声心动图检测肺动脉收缩压（PASP）≥35 mm Hg（1 mm Hg=0.133 kPa）.结果 随访2年,278例MHD患者中,53例（19.1％）死亡,其中28例死于主要心血管事件,87例（31.3％）患者有新发主要心血管事件.生存分析结果显示伴有PH的MHD患者全因死亡、心血管死亡及新发主要心血管事件发生率均高于不伴PH患者,差异有统计学意义（P＜0.05）.Cox回归分析显示PH患者校正后的风险值分别为HR=1.85,95％CI：1.03～3.34;HR =2.36,95％CI：1.05～5.31和HR =2.27,95％ CI：1.44～3.58.结论 PH是MHD患者全因死亡、心血管死亡及新发主要心血管事件的独立危险因素.建议MHD患者常规每年行一次心脏超声检查筛查PH以便更好地进行预后的危险分层.     

心力衰竭患者出院静息心率对全因死亡的影响

目的：探讨心力衰竭（心衰）患者出院静息心率对全因死亡的影响。方法：采用队列研究方法，以2006～2016年开滦研究人群中首次诊断为心衰的职工为研究对象，根据出院静息心率四分位水平分为：出院静息心率<65次/min组、65～71次/min组、72～79次/min组、≥80次/min组。采用Kaplan-Meier生存分析曲线计算各组累积全因死亡率，并使用log-rank检验比较组间差异，采用多因素Cox回归分析和限制性立方样条分析出院静息心率对心衰患者全因死亡的影响。结果：纳入符合标准的研究对象2 657例，平均年龄（67.85±11.44）岁，其中男性2 338(87.99%)例。平均随访（6.82±3.93）年期间，共发生全因死亡1 129例，出院静息心率<65次/min组至≥80次/min组累积全因死亡率分别为36.87%、38.27%、43.82%和50.07%。多因素Cox回归分析结果显示，校正年龄、性别等混杂因素后，与<65次/min组比较，65～71次/min组、72～79次/min组、≥80次/min组患者发生全因死亡的HR(95%CI)分别为0.95(...     

冠心病患者新发恶性肿瘤情况及其与全因死亡的相关性

【摘要】目的：明确冠心病患者新发恶性肿瘤情况及其与冠心病患者全因死亡的关联,为优化冠心病患者临床综合管理策略提供依据。方法：根据纳排标准,通过SPSS 25.0随机抽取2011年1月1日至2015年12月31日在中国人民解放军总医院第一医学中心心血管内科住院,首次行冠状动脉造影并明确诊断为冠心病的患者共4625例,收集患者基线资料,并对患者出院后的肿瘤情况和死亡情况进行随访。采用Cox回归分析明确新发恶性肿瘤与冠心病患者全因死亡的相关性。结果：随访成功3720名患者,随访成功率80.43%,中位随访时间为8年;在3720名患者中,发生恶性肿瘤150例（4.0%）,全因死亡335例（9.0%）;335例死亡的冠心病患者中新发恶性肿瘤40例（12%）。多因素校正后,Cox回归分析显示新发恶性肿瘤使冠心病患者全因死亡风险增加3.815倍(95% CI：2.362~6.164,P<0.001）。结论：本研究所纳入冠心病患者新发恶性肿瘤粗发生率4.0%,死亡的冠心病患者中新发恶性肿瘤粗发生率12%,冠心病患者新发恶性肿瘤与冠心病患者全因死亡显著相关,是冠心病患者长期生存预后的独立危险因素,提示在冠心病患者的长期管理策略中,应加强对肿瘤的筛查和管理以获得更好的预后。 关键词：冠心病;恶性肿瘤;全因死亡;随访     

中青年肥厚型心肌病患者心肌纤维化与临床表型和预后的关系

目的 探讨中青年肥厚型心肌病（HCM）患者心肌纤维化与临床表型和预后的关系。方法 收集并评估2011年3月至2019年4月就诊于中国医学科学院阜外医院的年龄<45岁的304例HCM患者。每例患者均进行了心脏磁共振成像心肌延迟强化（LGE）检查。根据LGE定量结果将HCM患者按三分位法分为3组。结果 LGE <2.53%、2.53%≤LGE <6.80%、LGE≥6.80%组HCM患者室壁最大厚度分别为（21.1±5.1）mm、（25.1±5.9）mm、（26.6±6.4）mm,心肌纤维化程度越高,室壁厚度越厚（P <0.001）。3组患者确诊年龄、性别及纽约心脏病协会（NYHA）心功能分级差异均无统计学意义（P> 0.05）。本组患者平均随访时间（5.4±1.9）年。随访过程中12例患者发生全因死亡事件,其中11例患者经历了心血管死亡,8例患者为心源性猝死。LGE≥6.80%组HCM患者全因死亡发生率为9.1%(9/99),9例全因死亡事件均为心血管死亡,其中6例为心源性猝死,死亡率高于其余两组（全因死亡发生率分别为1.0%、2.1%,P <0.01...     

“新四联”背景下伊伐布雷定治疗慢性心力衰竭的有效性和安全性

目的：评估“新四联”背景下伊伐布雷定用于治疗慢性心力衰竭的有效性及安全性。方法：回顾性收集2021年3月至2022年6月在南京鼓楼医院住院治疗的656例慢性心力衰竭患者的临床资料,应用伊伐布雷定患者为观察组（n=295）,未使用伊伐布雷定患者为对照组（n=361）。两组患者均采用“新四联”药物治疗方案治疗。倾向性评分匹配后观察组和对照组分别有268例患者匹配成功。比较两组患者治疗1年的有效性（主要终点为出院后1年内心血管死亡和心力衰竭恶化再住院的复合终点事件,次要终点为心力衰竭恶化再住院、全因再住院、心血管死亡和全因死亡）和安全性指标（包括心动过缓、心房颤动、视力模糊、肾功能损伤、高血压）。绘制Kaplan-Meier生存曲线,采用Cox比例风险回归模型分析两组与终点结局的相关性,并进行亚组分析。结果：匹配后,两组患者基线特征差异均无统计学意义。Kaplan-Meier生存曲线分析显示,观察组主要终点事件（P=0.031）、心力衰竭恶化再住院（P=0.020）和全因再住院（P=0.036）的发生率均低于对照组。多因素Cox比例风险回归模型分析显示,观察组的主要终点事件发生率（P=0.0...     

CAS评分和CHA2DS2-VASc评分指导我国非瓣膜性心房颤动患者抗凝治疗的预后比较

目的比较CAS和CHA2DS2-VASc评分两种卒中风险评估模型预测非瓣膜性心房颤动(房颤)患者全因死亡、血栓栓塞、大出血事件以及复合终点发生方面的差异。方法本研究为回顾性队列研究。从中国房颤注册研究(CAFR)中, 选取年龄>18岁的非瓣膜性房颤患者, 随机分为CAS评分组和CHA2DS2-VASc评分组, 并根据基线和随访过程中抗凝状态筛选出2组中依从评分规范抗凝的患者纳入本研究。收集并比较两组患者的年龄、性别等基本信息, 并定期进行随访, 随访内容包括是否接受抗凝治疗以及终点事件。终点事件为全因死亡、血栓栓塞和大出血事件, 复合终点事件为全因死亡和血栓栓塞事件。分析CAS评分组和CHA2DS2-VASc评分组相关终点事件发生情况, 并采用多因素Cox比例风险模型比较两组相关终点事件发生率的差异。结果共纳入5 206例房颤患者, 年龄(63.6±12.2)岁, 女性2 092例(40.2%)。其中CAS评分组2 447例(47.0%), CHA2DS2-VASc评分组2 759例(53.0%)。CAS组左心室射血分数<55%、非阵发性房颤、口服华法林比例以及HAS-BL...     

糖尿病合并脓毒症患者的主要不良心血管事件及全因死亡发生风险分析

目的 探讨糖尿病合并脓毒症患者住院30天内主要不良心血管事件（MACE）的发生特点及全因死亡的发生风险。方法 共纳入720例脓毒症患者,根据是否合并糖尿病分为合并糖尿病组252例和无糖尿病组468例,比较两组患者MACE及全因死亡的发生情况及住院第1～15天(D₁₅)和第16～30天(D₃₀)MACE发生特点。结果 合并糖尿病组患者的MACE发生率为36.5%,明显高于无糖尿病组的22.2%（P<0.05）,但两组患者急性脑血管意外发生率比较差异无统计学意义（P＞0.05）;合并糖尿病组患者的全因死亡发生率为25.0%,明显高于无糖尿病组的15.6%（P<0.05）。两组患者D₁₅的急性冠脉综合征、急性心力衰竭、严重心律失常、心源性死亡发生率分别高于比同组D₃₀（P<0.05）,但两组D₁₅和D₃₀的急性脑血管意外发生率同组内比较差异均无统计学意义（P>0.05）。多因素logistic回归分析结果显示,糖尿病是脓毒症患者发生MACE的独立预测因素(P<0.05)。结论 合并糖尿病的脓毒症患者住院30天期间MACE和全因死亡的发生率明显升高,有效控制血糖可能减少合并糖尿病的脓毒症患者MACE和全因死亡的发生。     

Recent mortality of Japanese patients with atrial fibrillation in an urban city of Tokyo

Background

In Japan, the recent status of the mortality of atrial fibrillation (AF) patients is still unclear.

Methods and results

We used a single-hospital based cohort database in an urban city (Tokyo) in Japan, including all the new visitors from 2004 to 2009 (n = 13,228). The non-adjusted death rates of AF patients for all-cause, stroke, and cardiovascular death were 1091, 97, and 727 per 100,000 patient-years, and the age-adjusted ones were 317 (95% CI, 316–318), 16 (95% CI, 16–16), and 238 (95% CI, 237–239), respectively. The age-adjusted relative risk of AF on all-cause mortality was 1.7 in the particular population.

Conclusions

The present study provides the most recent data about the characteristics and the mortality of AF patients in Tokyo, thus serving as the basic information for finding problems to solve regarding Japanese AF patients.     

Clinical implication of frailty assessment in older patients with atrial fibrillation

BackgroundWe aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA₂DS₂-VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AF patients.MethodsWe retrospectively evaluated 365 patients (≥65 years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA₂DS₂-VASc and HAS-BLED scores were calculated based on the electronic medical records and the frailty index was computed from the CGA data. The primary outcomes were cardiovascular and all-cause mortality.ResultsFrailty status was positively associated with the CHA₂DS₂-VASc score (P < 0.001) and the HAS-BLED score (P = 0.01). Patients with high CHA₂DS₂-VASc and HAS-BLED scores were more likely to be treated with anticoagulants rather than antiplatelet agents. However, frailty status was not associated with antithrombotic therapy. During the follow-up period (median [interquartile range], 22.9 [8.4–42.2] months), 141 patients (38.6%) died, of which 48 were due to cardiovascular events. CHA₂DS₂-VASc score could predict cardiovascular mortality, but not all-cause mortality. In contrast, frailty status was the independent predictor for both cardiovascular and all-cause mortality after adjusting for possible confounders (hazard ratio for all-cause mortality, 4.549; 95% CI, 2.756–7.509; P < 0.001).ConclusionFrailty assessment can be used to predict mortality in older AF patients, and provides additional prognostic value, along with the CHA₂DS₂-VASc and HAS-BLED scores.     

Cardiac resynchronization therapy in patients with atrial fibrillation: A meta-analysis

Background and ObjectiveTo combine the results of the best scientific evidence in order to compare the effects of cardiac resynchronization therapy (CRT) in heart failure patients with atrial fibrillation (AF) and in sinus rhythm (SR) and to determine the effect of atrioventricular nodal ablation in AF patients.MethodsThe electronic databases PubMed, B-On and Cochrane CENTRAL were searched, and manual searches were performed, for randomized controlled trials and cohort studies up to November 2012. The endpoints analyzed were all-cause and cardiovascular mortality and response to CRT.ResultsWe included 19 studies involving 5324 patients: 1399 in AF and 3925 in SR. All-cause mortality was more likely in patients with AF compared to patients in SR (OR=1.69; 95% CI: 1.20–2.37; p=0.002). There were no statistically significant differences in cardiovascular mortality (OR=1.36; 95% CI: 0.92–2.01; p=0.12). AF was associated with an increased likelihood of lack of response to CRT (OR=1.41; 95% CI: 1.15–1.73; p=0.001). Among subjects with AF, ablation of the atrioventricular node was associated with a reduction in all-cause mortality (OR=0.42; 95% CI: 0.22–0.80; p=0.008), cardiovascular death (OR=0.39; 95% CI: 0.20–0.75; p=0.005) and the number of non-responders to CRT (OR=0.30; 95% CI: 0.10–0.90; p=0.03).ConclusionsThe presence of AF is associated with increased likelihood of all-cause death and non-response to CRT, compared to patients in SR. However, many patients with AF benefit from CRT. Atrioventricular nodal ablation appears to increase the benefits of CRT in patients with AF.     

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly: a prospective cohort study and propensity score analysis

BackgroundIt is unclear whether catheter ablation (CA) for atrial fibrillation (AF) affects the long-term prognosis in the elderly. This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.MethodsPatients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study. Participants who underwent CA at baseline were propensity score matched (1:1) with those who did not receive CA. The outcome events included all-cause mortality, cardiovascular mortality, stroke/transient ischemic attack (TIA), and cardiovascular hospitalization.ResultsOverall, this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions. During a mean follow-up of 39.75 ± 19.98 months (minimum six months), 24 patients died in the ablation group, compared with 60 deaths in the non-ablation group [hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.30-0.79, P = 0.0024]. Besides, 6 ablated and 29 non-ablated subjects died of cardiovascular disease (HR = 0.25, 95% CI: 0.11–0.61, P = 0.0022). A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA (HR = 0.79, 95% CI: 0.48–1.28, P = 0.3431). In addition, 140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization (HR = 0.84, 95% CI: 0.67–1.04, P = 0.1084). Subgroup analyses according to gender, type of AF, time since onset of AF, and anticoagulants exposure in initiation did not show significant heterogeneity.ConclusionsIn elderly patients with AF, CA may be associated with a lower incidence of all-cause and cardiovascular mortality.     

Effects of angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor blocker on one-year outcomes of patients with atrial fibrillation:insights from a multicenter registry study in China

ObjectiveTo evaluate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) therapy on the prognosis of patients with atrial fibrillation (AF).MethodsA total of 1, 991 AF patients from the AF registry were divided into two groups according to whether they were treated with ACEI/ARB at recruitment. Baseline characteristics were carefully collected and analyzed. Logistic regression was utilized to identify the predictors of ACEI/ARB therapy. The primary endpoint was all-cause mortality, while the secondary endpoints included cardiovascular mortality, stroke and major adverse events (MAEs) during the one-year follow-up period. Univariable and multivariable Cox regression were performed to identify the association between ACEI/ARB therapy and the one-year outcomes.ResultsIn total, 759 AF patients (38.1%) were treated with ACEI/ARB. Compared with AF patients without ACEI/ARB therapy, patients treated with ACEI/ARB tended to be older and had a higher rate of permanent AF, hypertension, diabetes mellitus, heart failure (HF), left ventricular ejection fraction (LVEF) < 40%, coronary artery disease (CAD), prior myocardial infarction (MI), left ventricular hypertrophy, tobacco use and concomitant medications (all P < 0.05). Hypertension, HF, LVEF < 40%, CAD, prior MI and tobacco use were determined to be predictors of ACEI/ARB treatment. Multivariable analysis showed that ACEI/ARB therapy was associated with a significantly lower risk of one-year all-cause mortality [hazard ratio (HR) (95% CI): 0.682 (0.527-0.882), P = 0.003], cardiovascular mortality [HR (95% CI): 0.713 (0.514-0.988), P = 0.042] and MAEs [HR (95% CI): 0.698 (0.568-0.859), P = 0.001]. The association between ACEI/ARB therapy and reduced mortality was consistent in the subgroup analysis.ConclusionsIn patients with AF, ACEI/ARB was related to significantly reduced one-year all-cause mortality, cardiovascular mortality and MAEs despite the high burden of cardiovascular comorbidities.     

The association between the prognostic nutritional index and 28-day mortality among atrial fibrillation patients in China over 80 years of age

Backgrounds and aimsThe most prevalent form of cardiac rhythm abnormality among older populations is atrial fibrillation (AF). The prognostic nutritional index (PNI) is a reliable predictor of mortality in various diseases. The association between the PNI and mortality among AF patients over 80 years remains uncleared.Methods and resultsA retrospective assessment of AF cases admitted to a single cardiovascular disease unit in China between January 2015 and June 2020 was performed. The PNI at admission was defined as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm³). The association between PNI and cardiovascular disease (CVD)-related or all-cause mortality within 28 days was assessed via multivariable Cox regression. The analysis included 1141 patients. The CVD-related and all-cause mortality rates were 3.3% and 8.7%. Kaplan-Meier analyses revealed that cases with lower PNI tertiles exhibited higher all-cause mortality (T1: 7.6%; T2: 6.1%; T3: 2.4%, P < 0.001) or CVD mortality (T1: 6.3%; T2: 2.9%; T3: 0.8%, P < 0.001). After adjusting for potential confounders, continuous PNI was negatively related to the hazard of all-cause mortality (HR 0.92, 95% CI 0.89, 0.96) and CVD-related mortality (HR 0.90, 95% CI 0.84, 0.95). Compared to the T1 group, patients with a higher PNI exhibited a lower risk of all-cause mortality (P for trend 0.003) and CVD-related mortality (P for trend 0.005). Among most subgroups, CVD-related and all-cause mortality decreased with elevating PNI values.ConclusionsPNI is significantly negatively correlated with CVD-related and all-cause mortality among AF cases over 80 years.     

心房颤动的治疗：前景光明

Great achievements have been made in management of atrial fibrillation （AF） , including drug therapy, catheter ablation and percutaneous closure of left atrial appendage in recent years. The development of new generation anticoagulation drugs will hopefully be a landmark in the management of AF. It was shown in RELY study that dabigatran, a direct competitive inhibitor of thrombin,was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage as compared with warfarin. ATHENA study revealed that dronedarone reduced the incidence of stroke and hospitalization due to cardiovascular events or death in patients with AF. Dronedarone, a new antiarrhythmic drug, was approved by FDA for management of AF. Catheter ablation of AF has emerged as a mainstream therapy,it was shown in a recent study that the incidence of stroke in the patients underwent successful ablation was only 0.07%. This study estabolished the fact that successful catheter ablation of AF could improve the outcome of patients with AF. In the field of device therapy of AF, PROTECT-AF confirmed that percutaneous closure of left atrial appendage was not inferior to warfarin with regard to prevention of stroke in patients with AF.     

Prognostic implications of adherence to oral anticoagulants among patients with atrial fibrillation: Insights from MISOAC-AF trial

ObjectivesTo explore the implications of adherence to oral anticoagulants (OACs) on all-cause mortality and cardiovascular outcomes in patients with atrial fibrillation (AF).MethodsThis post-hoc analysis of the MISOAC-AF trial included recently hospitalized patients with AF. Adherence to OACs was assessed by the proportion of days covered (PDC). Good adherence was defined as PDC >80 %. Cox regression models were used to associate PDC with clinical outcomes of all-cause death, cardiovascular death (CVD), stroke, and bleeding. A sub-analysis was performed among adherent patients to compare outcomes between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs).ResultsDuring a median 31-month follow-up, 778 cardiac patients with comorbid AF who had been prescribed OACs upon hospital discharge were studied. The mean PDC was 0.78; 66 % of patients had good adherence (>80 %) which was associated with lower risk of all-cause death [adjusted hazard ratio (aHR): 0.64; 95 % confidence interval (CI): 0.46 to 0.84, p < 0.001] and CVD (aHR: 0.70; 95 % CI: 0.50 to 0.97, p = 0.03). The risk of stroke and major or non-major bleeding did not differ by adherence status. Among adherent patients to OACs, VKA use was associated with higher rates of all-cause death (p < 0.001), CVD (p < 0.001), and stroke (p = 0.01); no differences were found regarding major or non-major bleeding risk.ConclusionsIn recently hospitalized patients with AF, good adherence to OACs was associated with a reduced risk of all-cause death and CVD. The rates of stroke or bleeding events were not significantly different. VKAs were associated with more adverse events compared to DOACs.     

Left atrial thrombus and prognosis after anticoagulation therapy in patients with atrial fibrillation

Background

Anticoagulation therapy reduces the risk of thromboembolic events by two-thirds in patients with atrial fibrillation (AF). The prevalence of left atrial thrombus (LAT) in AF patients with anticoagulation therapy has not been fully investigated.

Purpose

To investigate the prevalence of LAT and its impact on the outcomes in patients with nonvalvular AF after anticoagulation therapy.

Methods

This study consisted of 231 patients with nonvalvular AF who had transthoracic (TTE) and transesophageal echocardiographic (TEE) examinations more than 3 weeks after anticoagulation therapy. The clinical and echocardiographic characteristics were evaluated.

Results

LAT was observed in 13 (8.8%) of 148 patients with sub-therapeutic anticoagulation, and in 3 (3.6%) of 83 patients with sufficient anticoagulation. The presence of LAT was associated with higher CHADS₂ score, decreased LA volume changes and the presence of spontaneous echocardiographic contrast (SEC) in patients with sub-therapeutic anticoagulation. Patients with LAT after sufficient anticoagulation were male with permanent AF who had decreased left ventricular systolic and diastolic function and dilated LA on TTE and SEC, and reduced appendage flow velocity on TEE. Patients with LAT had worse cardiovascular outcomes compared with those without LAT (p = 0.02).

Conclusions

We demonstrated that LAT was a univariate risk factor associated with worse cardiovascular outcomes, which was observed in 8.8% of patients with sub-therapeutic anticoagulation and 3.6% of patients with sufficient anticoagulation.     

经导管冷冻消融治疗心房颤动的中期疗效评价

目的探讨经导管冷冻消融治疗心房颤动(简称房颤)的安全性和有效性。方法2005年1月至2007年3月本中心共有24例房颤患者接受了经导管冷冻消融肺静脉隔离术,其中22例为阵发性房颤,2例为持续性房颤,消融的终点是肺静脉电位消失。随访成功的定义为术后3个月后无症状性快速性房性心律失常发生。结果22例实现肺静脉电位消失(91.7%),随访15.9±7.5个月,其中18例恢复窦性心律未再发作房颤(8例未服抗心律失常药物),消融首次成功率81.8%(18/22),2例出现心房扑动,1例出现短阵房性心动过速。严重并发症包括1例术后心包压塞,1例一过性窦性停搏伴下壁导联ST段抬高,1例一过性脑气栓,无死亡病例。其中心包压塞者进行了心包穿刺引流术后痊愈。ST段抬高性心室停搏予心室起搏、硝酸甘油静脉点滴后好转。一过性脑气栓的患者经过对症治疗后好转,未留下神经系统后遗症。结论经导管冷冻消融治疗房颤是较安全和有效的。