左房压与风险评分在房颤导管消融患者保留射血分数心力衰竭评估中的不一致。

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2025-10-09 DOI:10.1093/europace/euaf245

Monika Gawałko, Zarina Habibi, Dominique Verhaert, Jerremy Weerts, Bouke Adriaans, Sevasti-Maria Chaldoupi, Rachel M A Ter Bekke, Dennis W Den Uijl, Justin G L M Luermans, Vanessa P M Van Empel, Ulrich Schotten, Kevin Vernooy, Dominik Linz

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引用次数: 0

摘要

背景：确定房颤（AF）患者保留射血分数（HFpEF）发生心力衰竭的风险或可能性具有挑战性。目的：评估房颤导管消融患者LAP升高的患病率及相关因素，并评价LAP升高与HFpEF风险评分之间的一致性。方法：本研究纳入336例行导管消融治疗的有症状房颤患者（中位年龄65岁，41%为女性）。LAP升高定义为平均LAP≥15 mmHg。高HFpEF概率定义为H2FPEF≥6和/或HFA-PEFF≥5。结果：37% （n=125）的患者存在LAP升高，与LAP升高相关的因素包括较高的身体质量指数（BMI; OR 1.21, 95% CI 1.11-1.31）和较低的LA库菌株（OR 0.97, 95% CI 0.94-0.99）。全身麻醉和非窦性心律与较高的LAP有关，但不是独立的；AF型无明显影响。在204例符合条件的患者中，36%的患者有高的HFpEF概率。在12个月内，无论LAP状态如何，AF复发（26%对24%，p=0.775）和重复消融（11%对7.2%,p=0.230）相似，但严重不良事件（死亡、危及生命的情况、住院或持续残疾）在LAP升高的患者中更为常见（6.7%对1.7%,p=0.044）。结论：超过三分之一的消融患者LAP升高。与HFpEF评分的不一致表明在房颤患者中的应用有限。

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Discordance between left atrial pressure and risk scores in assessment of heart failure with preserved ejection fraction in patients with atrial fibrillation undergoing catheter ablation.

Background: Identifying risk or probability of heart failure with preserved ejection fraction (HFpEF) in patients with atrial fibrillation (AF) is challenging.

Purpose: To assess the prevalence and factors associated with elevated LAP in AF patients undergoing catheter ablation and to evaluate the concordance between elevated LAP and HFpEF risk scores.

Methods: This study included 336 symptomatic AF patients (median age 65 years, 41% female) undergoing catheter ablation. Elevated LAP was defined as a mean LAP≥15 mmHg. High HFpEF probability was defined by H2FPEF≥6 and/or HFA-PEFF≥5.

Results: Elevated LAP was present in 37% (n=125) of patients, and factors associated with elevated LAP included higher body mass index (BMI; OR 1.21, 95% CI 1.11-1.31) and lower LA reservoir strain (OR 0.97, 95% CI 0.94-0.99). General anaesthesia and non-sinus rhythm were linked to higher LAP but not independently; AF type showed no effect. Among 204 eligible patients, 36% had a high HFpEF probability. Over 12 months, AF recurrence (26% vs 24%, p=0.775) and repeat ablations (11% vs 7.2%, p=0.230) were similar regardless of LAP status, but severe adverse events (death, life-threatening situations, hospitalizations or persistent disability) were more common in those with elevated LAP (6.7% vs. 1.7%, p=0.044).

Conclusions: Over one-third of ablation patients had elevated LAP. Poor agreement with HFpEF scores suggests limited utility in AF patients.

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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.