How to Assess the Functional Impact of Atrial Fibrillation in Patients With Heart Failure

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Naoya Kataoka, Teruhiko Imamura
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引用次数: 0

Abstract

A well-established interplay exists between atrial fibrillation (AF) and heart failure (HF). However, the specific adverse impact of AF on quality of life among HF patients remains incompletely elucidated. The authors demonstrated that the presence of AF and reduced ejection fraction was associated with a lesser degree of improvement in functional class and the physical dimension of a quality-of-life questionnaire [1]. Several concerns merit consideration.

In the present study, patients with HF were included regardless of their left ventricular ejection fraction (LVEF) [1]. Prior studies focusing on HF populations over 60 years of age have shown that quality-of-life profiles and depressive symptoms differ significantly between cohorts with preserved versus reduced LVEF [2]. To better delineate the target population, it may be more appropriate to restrict the LVEF range.

The study did not differentiate between paroxysmal and persistent forms of AF [1]. Patients with paroxysmal AF may experience a more favorable quality of life, particularly when sinus rhythm is intermittently or spontaneously restored [3]. Stratification by AF subtype and burden may provide deeper insight into the differential impact on patient-reported outcomes.

The definition of arrhythmia-induced cardiomyopathy warrants clarification. This condition is typically diagnosed by the observation of reverse remodeling following the resolution of the causative arrhythmia [4]. It may be reasonable to consider arrhythmia-induced cardiomyopathy within the broader category of idiopathic cardiomyopathies, given its distinct pathophysiological trajectory.

In the current era, catheter ablation has emerged as a standard therapeutic option for AF in patients with HF [5]. Notably, in the present study, great improvement in New York Heart Association functional class was achieved with pharmacological therapy alone. A discussion regarding the therapeutic approach—namely, rhythm control versus rate control—would enhance the clinical relevance of the study's findings in the context of contemporary HF management.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

如何评估心力衰竭患者心房颤动对功能的影响
心房颤动(AF)和心力衰竭(HF)之间存在着公认的相互作用。然而,房颤对心衰患者生活质量的具体不良影响仍未完全阐明。作者证明,房颤和射血分数降低与功能等级和生活质量问卷物理维度的改善程度较低相关。有几个问题值得考虑。在本研究中,无论其左心室射血分数(LVEF)[1]如何,HF患者均被纳入研究。先前针对60岁以上心衰人群的研究表明,LVEF水平保持与降低的人群在生活质量和抑郁症状方面存在显著差异。为了更好地界定目标人群,限制最低生活水平的范围可能更合适。该研究没有区分阵发性和持续性房颤。阵发性房颤患者的生活质量较好,特别是当窦性心律间歇性或自发恢复时。根据房颤亚型和负担进行分层可以更深入地了解对患者报告结果的差异影响。心律失常引起的心肌病的定义需要澄清。这种情况通常通过观察诱发性心律失常消退后的反向重构来诊断。考虑到其独特的病理生理轨迹,将心律失常引起的心肌病纳入特发性心肌病的更广泛类别可能是合理的。在当前时代,导管消融已成为心房颤动合并心衰患者的标准治疗选择。值得注意的是,在本研究中,仅通过药物治疗,纽约心脏协会功能等级有了很大的改善。关于治疗方法的讨论-即,节律控制与心率控制-将增强研究结果在当代心衰管理背景下的临床相关性。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
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
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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