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目的探讨心房颤动(简称房颤)对慢性收缩性心力衰竭(CSHF)及慢性射血分数正常心力衰竭(HFPSF)住院患者预后的影响。方法前瞻性分析武汉地区4家三级甲等教学医院848例心力衰竭(简称心衰)患者,根据左室射血分数分为CSHF组(n=560)、HFPSF组(n=288)。每组根据有无房颤又分为房颤与非房颤亚组。单因素Kaplan-Meier曲线分别分析CSHF和HFPSF患者房颤亚组和非房颤亚组总死亡、心脏泵功能衰竭死亡(心衰死亡)、心源性猝死和栓塞相关死亡的差异。多因素Cox风险比例模型分别比较CSHF和HFPSF患者房颤亚组与非房颤亚组不同预后的差异。结果单因素分析发现,CSHF和HFPSF组房颤亚组与非房颤亚组总死亡无差异。CSHF组中与非房颤亚组(n=374)相比,房颤亚组(n=186)心衰死亡增高(P=0.01)、栓塞相关死亡增加(P<0.01)。HFPSF组房颤亚组(n=140)和非房颤亚组(n=148)心衰死亡、心源性猝死和栓塞相关死亡无差异(P>0.05)。多因素Cox风险比例模型分析发现房颤增加CSHF患者栓塞相关死亡风险(HR=2.106,95%CI:1.436~2.719,P<0.01)。结论房颤对CSHF和HFPSF患者预后的影响存在差异,仅增加CSHF患者栓塞相关死亡风险。房颤影响CSHF患者预后的原因可能不在于心律失常本身而在于其并发症。
Objective To investigate the effect of atrial fibrillation (AF) on the prognosis of hospitalized patients with chronic systolic heart failure (CSHF) and chronic heart failure (HFPSF). Methods A total of 848 patients with heart failure (HF) in 4 tertiary teaching hospitals in Wuhan were prospectively analyzed. Patients were divided into CSHF group (n = 560) and HFPSF group (n = 288) according to left ventricular ejection fraction. Each group was divided into atrial fibrillation and non-atrial fibrillation subgroup according to the presence or absence of atrial fibrillation. Univariate Kaplan-Meier curves were used to analyze the differences of total deaths, heart failure (heart failure), sudden cardiac death and embolism-related deaths between subgroups of atrial fibrillation and non-atrial fibrillation in CSHF and HFPSF patients. The multivariate Cox proportional hazards model was used to compare the differences in prognosis of patients with and without AF in CSHF and HFPSF patients. Results Univariate analysis showed that there was no difference in total deaths between the subgroups of AF and non-AF in CSHF and HFPSF groups. Compared with non-AF subgroup (n = 374), CSHF group had higher HF death (P = 0.01) and increased embolism-related death (P <0.01). Heart failure, sudden cardiac death and embolism-related death in HFPSF group (n = 140) and non-AF subgroup (n = 148) were not significantly different (P> 0.05). A multivariate Cox proportional hazard model analysis found that atrial fibrillation increased the risk of embolism-related death in patients with CSHF (HR = 2.106, 95% CI: 1.436-2.719, P <0.01). Conclusion The effects of atrial fibrillation on the prognosis of patients with CSHF and HFPSF are different, only increasing the risk of embolism-related death in patients with CSHF. The cause of atrial fibrillation affecting the prognosis of patients with CSHF may not lie in the arrhythmia itself but in its complications.