[心房功能性二尖瓣反流对HFpEF合并心房颤动患者最佳药物治疗期间临床结局的影响]。

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Terapevticheskii Arkhiv Pub Date : 2025-08-28 DOI:10.26442/00403660.2025.08.203337

A F Safarova, Z D Kobalava, S B Adam, T M Timofeeva

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引用次数: 0

摘要

目的：探讨保留射血分数（HFpEF）合并心房颤动（AF）心力衰竭患者心房功能性二尖瓣反流（AFMR）在最佳药物治疗背景下的临床及预后意义。材料与方法：在最佳药物治疗背景下，对150例HFpEF合并AF和AFMR患者（年龄75.5±9.9岁，男性占54%）进行回顾性研究。评估临床和人口学特征（包括临床状况评估量表）、实验室和仪器诊断结果以及药物治疗。使用多参数方法评估MR为轻度、中度或重度，包括评估回流孔的有效面积和MR分数。在589（217-1039）天的随访期间，研究了AFMR对HF再住院的影响，联合终点（CE）[心血管死亡（CVD）和再住院]。结果：中度AFMR 80例（53.3%），重度AFMR 23例（15.3%）。这些患者的收缩压和舒张压值较低（p = 0.014），与轻度mr患者相比，永久性房颤在这些患者中更为常见（p = 0.025），中/重度AFMR的独立预测因素是房颤的恒定形式（OR 3.3 [1.4-8.0]; p = 0.007），收缩期末左心室距离（OR 3.0 [1.4-6.5]; p = 0.006），服用抗血小板药物（OR 0.11 [0.02-0.70]; p = 0.020）。在普通组中，CE的发生率为46.7%，HF的发生率为34.0%，CVD的发生率为14.0%。CE的预测因子为中度/重度FMR（风险比2.6 [1.4-4.9],p = 0.002）、临床状况评估量表得分（风险比1.14 [1.04-1.25],p = 0.003）；重度FMR （HR 4.1 [1.7-10.2], p = 0.002）、中度FMR （HR 2.7 [1.2-5.8], p = 0.013）、肌酐水平（HR 0.990 [0.980- 1000], p = 0.040）。结论：尽管存在局限性，但AFMR作为影响HFpEF和AF患者临床结局的重要因素已得到证实。目前的研究强调需要进一步调查这种情况和个性化的病人管理策略的发展。

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[Impact of atrial functional mitral regurgitation on clinical outcomes in patients with HFpEF and atrial fibrillation during optimal drug therapy].

Aim: To evaluate the clinical and prognostic significance of atrial functional mitral regurgitation (AFMR) in patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) on the background of optimal drug therapy.

Materials and methods: The retrospective study included 150 patients (age 75.5 ± 9.9 years, 54% men) with HFpEF with AF and AFMR on the background of optimal drug therapy. Clinical and demographic characteristics (including the scale of assessment of the clinical condition), laboratory and instrumental diagnostic results, and drug therapy were evaluated. MR was assessed as minor, moderate, or severe using a multiparametric approach, including an assessment of the effective area of the regurgitation hole and the MR fraction. The effect of AFMR on rehospitalization for HF, combined endpoint (CE) was studied [cardiovascular death (CVD) and rehospitalization] during the follow-up period of 589 (217-1039) days.

Results: Eighty (53.3%) patients had moderate AFMR, and 23 (15.3%) had severe AFMR. These patients had lower SBP and DBP values (p = 0.014), and permanent AF was more common among them (p = 0.025) compared with patients with minor MR. Independent predictors of moderate/severe AFMR were the constant form of AF (OR 3.3 [1.4-8.0]; p = 0.007), end-systolic left ventricular distance (OR 3.0 [1.4-6.5]; p = 0.006), taking antiplatelet agents (OR 0.11 [0.02-0.70]; p = 0.020). The frequency of outcomes in the general group was 46.7% for CE, 34.0% for rehospitalization for HF, and 14.0% for CVD. The predictors of CE were moderate/severe FMR (HR 2.6 [1.4-4.9]; p = 0.002), scores on the scale of assessment of the clinical condition (HR 1.14 [1.04-1.25]; p = 0.003); severe FMR (HR 4.1 [1.7-10.2]; p = 0.002), moderate FMR (HR 2.7 [1.2-5.8]; p = 0.013), creatinine level (HR 0.990 [0.980-1,000]; p = 0.040).

Conclusion: Despite the limitations, the importance of AFMR as a factor influencing clinical outcomes in patients with HFpEF and AF has been demonstrated. The present study highlights the need for further investigation of this condition and the development of personalized patient management strategies.

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来源期刊

Terapevticheskii Arkhiv 医学-医学：内科

CiteScore

1.40

自引率

33.30%

发文量

171

审稿时长

3-8 weeks

期刊介绍： Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.