心房颤动对慢性心力衰竭伴左室射血分数≥0．50患者预后的临床研究

Impact of atrial fibrillation on prognosis of chronic heart failure patients with left ventricular ejection fraction≥0.5

目的探讨左室射血分数（LVEF）≥0．50的住院慢性心力衰竭（心衰）患者中心房颤动（房颤）的发生和分布类型，及房颤对此类心衰预后的影响。方法调查患者417例次，按LVEF〈0．50与≥0．50分为两组，根据患者入院前是否有房颤病史分为阵发性房颤、持续性房颤及入院后新发房颤。随后观察并记录严重恶性事件发生情况及因慢性心衰而再入院次数及每两次住院的间隔时间。结果LVEF〈0．50的慢性心衰更多见于男性，一年内心肌梗死的发病率较LVEF≥0．50者高[15．6％（34／218）比8．0％（16／199），P〈0．01]，且房颤使得患者脑卒中发生率较不伴房颤者明显增高[24．3％（27／111）比8．4％（9／107），P〈0．053，急性冠脉综合征、心血管死亡事件例数及死亡数也高于不伴房颤者；在LVEF≥0．50的慢性心衰患者中新发房颤数量较LVEF〈0．50者明显增多（51比30，P〈0．05），房颤可见伴发在近2／3的患者中，且再入院次数较不伴房颤者增加[（2．78±1．79）次比（2．00±1．35）次，P〈0．013，前两次入院间隔时间亦较不伴房颤者缩短[（117±107）d比（154±130）d，P〈0．053。结论房颤更易发生在LVEF≥0．50的慢性心衰患者，导致更短的再入院间隔，强调治疗和管理这类房颤的重要性。

Objective To explore the prevalence, distribution type and impact of atrial fibrillation on prognosis of hospitalized patients with congestive heart failure （CHF） with left ventricular ejection fraction （LVEF） ≥0.50. Methods The medical records of 417 unselected consecutive patients with CHF were retrospectively reviewed. Patients were categorized as LVEF 〈0.50 or LVEF≥0.50. And they were also categorized by the past history of atrial fibrillation and divided into three groups： paroxysmal atrial fibrillation, continuous atrial fibrillation and onset of atrial fibrillation after admission. Then the vicious events, the number of readmission due to CHF and the interval between discharge and readmission were observed and recorded. Results Male patients were prevalent with CHF whose LVEF 〈 0.50. The occurrence of acute myocardial infarction in the 1st year [15.6% （34/218）3 was higher than that of CHF with LVEF≥0.5 [8.0% （16/199）, P〈0. 013. The occurrence of cerebral stroke in patients with atrial fibrillation [24.3% （27/111）3 was higher than that of patients without atrial fibrillation [8. 4% （9/107）, P〈0. 05）. The numbers of acute coronary syndrome and cardiac death were also increased. In the patients with CHF whose LVEF≥0.50 the incidence atrial fibrillation occurring after readmission was significantly higher than that of patient with CHF whose LVEF 〈0. 50 （51 vs. 30, P〈0. 05）. Atrial fibrillation could be found in nearly 2/3 of patients. And the number of readmission （2.78±1.79 vs. 2.00±1.35, P〈0. 01） was increased, while the interval between discharge and readmission [（117 ± 107） days vs. （154± 130） days, P〈0. 053 was shorter. Conclusion Atrial fibrillation occurs more likely in patients with CHF whose LVEF 0. 50, leading to a shorter interval of readmission. Therefore the importance of treatment of atrial fibrillation should be emphasized.