Clinical impact of atrial fibrillation progression in patients with heart failure with preserved ejection fraction: A report from the CHART-2 Study.

IF 7.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2024-08-30 DOI:10.1093/europace/euae218

Tomohiro Ito, Takashi Noda, Kotaro Nochioka, Takashi Shiroto, Nobuhiko Yamamoto, Hiroyuki Sato, Takahiko Chiba, Yuhi Hasebe, Makoto Nakano, Hiroyuki Takahama, Jun Takahashi, Satoshi Miyata, Hiroaki Shimokawa, Satoshi Yasuda

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引用次数: 0

Abstract

Aims: Atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), and clinical outcomes of patients with AF vary depending on its subtype. While AF progression characterized by the transition from paroxysmal AF to persistent AF is sometimes observed, the incidence and clinical impact of AF progression in patients with HFpEF remain to be explored.

Methods and results: We enrolled patients with HFpEF and paroxysmal AF from the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study. AF progression was defined as the transition from paroxysmal AF to persistent AF. A total of 718 patients (median age: 72 years, 36% were female) were enrolled. For a median follow-up of 6.0 years (interquartile range: 3.0-10.2 years), AF progression occurred in 105 patients (14.6%), with a cumulative incidence of 16.7% at 10 years. In the multivariable Cox proportional hazards model, previous hospitalization for heart failure [hazard ratio (HR) 1.74, 95% confidence interval (CI) 1.16-2.60; P = 0.007] and left atrial diameter (per 5-mm increase) (HR 1.37, 95% CI 1.20-1.55; P < 0.001) were significantly associated with AF progression. Furthermore, AF progression was significantly linked to worsening heart failure (adjusted HR 1.68, 95% CI 1.18-2.40; P = 0.004). Notably, 27 cases (26%) of worsening heart failure occurred within 1 year following AF progression.

Conclusion: In patients with HFpEF, AF progression is significantly associated with adverse outcomes, particularly worsening heart failure. An increased risk is observed in the early phases following progression to persistent AF.

Registration: Clinical Trials.gov Identifier: NCT00418041.

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射血分数保留型心力衰竭患者心房颤动进展的临床影响：CHART-2 研究报告

目的：心房颤动（AF）经常与射血分数保留型心力衰竭（HFpEF）并存，心房颤动患者的临床预后因其亚型而异。虽然有时会观察到房颤进展，其特征是从阵发性房颤过渡到持续性房颤，但房颤进展在射血分数保留型心力衰竭患者中的发生率和临床影响仍有待探讨：我们从 "东北地区慢性心力衰竭分析和登记-2（CHART-2）研究 "中招募了患有高频心力衰竭和阵发性房颤的患者。房颤进展的定义是从阵发性房颤转变为持续性房颤。共有 718 名患者（中位年龄：72 岁，36% 为女性）被纳入研究。在中位随访 6.0 年（四分位间范围：3.0-10.2 年）期间，105 名患者（14.6%）出现房颤进展，10 年的累积发生率为 16.7%。在多变量考克斯比例危险模型中，既往因心力衰竭住院（危险比 [HR] 1.74，95% 置信区间 [CI] 1.16-2.60；P=0.007）和左心房直径（每增加 5 毫米）（HR 1.37，95% CI 1.20-1.55；PConclusion：在高频心衰患者中，房颤进展与不良预后，尤其是心衰恶化密切相关。在进展为持续性房颤后的早期阶段观察到风险增加：注册：ClinicalTrials.gov Identifier：NCT00418041。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.