心房颤动对慢性收缩性心力衰竭患者远期预后影响分析

The longterm prognostic value of atrial fibrillation in patients with chronic systolic heart failure

目的探讨心房颤动（房颤）对慢性收缩性心力衰竭（chronic systoli cheart failure，CSHF）住院患者远期预后的影响。方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000年至2010年CSHF住院患者资料，单因素Kaplan．Meier曲线分析房颤和非房颤组总死亡、心血管病死亡、心脏泵功能衰竭死亡（心力衰竭死亡）、心脏性猝死和栓塞相关死亡差异。多因素Cox生存分析确认心力衰竭患者不同预后的危险因素。结果①共16681例患者纳入本次研究。房颤组与非房颤组相比，年龄（64．54＋13．61）岁比（62．19＋15．07）岁（P〈0．01）、左心室射血分数（LVEF）37．43±12．72比38．42＋13．96（P〈0．01）、心功能Ⅲ-Ⅳ级（NYHA分级）患者（5547／81．49％比7121／72．12％，P〈O．01）和病因等因素存在差异。②单因素Kaplan-Meier曲线分析发现，房颤组和非房颤组在总死亡、心血管病死亡、心力衰竭死亡和栓塞相关死亡存在差异，而在心律失常相关的心脏性猝死两组问差异无统计学意义。⑧多因素Cox回归分析发现房颤不是总死亡、心血管病死亡、心力衰竭死亡和心脏性猝死增加的独立危险因素，而增加栓塞相关死亡（HR=2．134，95％CI，1．846-2．430，P〈0．01）结论房颤不增加CSHF患者远期总死亡、心血管病死亡、心力衰竭死亡和心脏性猝死，而增加栓塞相关死亡。提示房颤引起CSHF患者远期预后不良的原因可能在于其并发症。

Objective To investigate the prognostic value of atrial fibrillation （AF） in patients with chronic systolic heart failure （CSHF）. Methods Data of inhospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Province. Inclusion criteria： over 18 years of age, organic heart disease and with the symptom of heart failure （HF） including dyspnea and fatigue. We excluded patients with a history of myocardial infarction in the prior 12 months, congenital heart disease, pericardial disease and the history of cancer. We used X2 tests and t tests for descriptive analyses. Univariate KaplanMeier curve was performed to evaluate the difference in prognosis between AF and nonAF group. Multivariate Cox regression analysis was performed to determinate the independent risk factors of allcause mortality, cardiovascular mortality, HF mortality, sudden cardiac death （SCD） and thrombosisrelated mortality, respectively. Statistical tests were evaluated with the use of 2tailed 95% confidence levels, and tests with P〈O. 01 were considered signifi cant. Data analyses were performed with the use of SPSS 13.0 for Windows, release 15, 2006 （SPSS Inc, Chicago, llI ）. Results 16681 patients were enrolled in the present study of which AF accounted for 40. 81% （6807 patients）. During（ 5. 82＋1. 63 ） years followup, 6453 patients died. The result of univariate Kaplan Meier curve showeds there was significant difference in allcause mortality, cardiovascular mortality, HF mortality and thrombosisrelated mortality while not in SCD. The result of multivariate Cox regression analysis showedAF was not the independent risk factor of allcause mortality, cardiovascular mortality, HF mortality or SCD. AF increased thrombosisrelated mortality （ HR = 2. 134, 95% CI, 1. 846 -2. 430, P 〈 0.01 ）. Conclusions AF increased thrombosisrelated mortality while not other endpoints in patients with CSHF which indicated AF correlated with adverse prognosis lies in its sideeffect while not the arrhythmia.