心力衰竭与心房颤动共存的流行病学和相关临床研究进展

The coexistence of heart failure and atrial fibrillation:progress in Epidemiology and related clinical research

心房颤动(atrial fibrillation,AF)和心力衰竭(heart failure,HF)经常共存,HF的两种亚型——射血分数保留型HF(HF with preserved ejection fraction,HFpEF)与射血分数降低型HF(HF with reduced ejection fraction,HFrEF)均在AF发生发展中起重要作用,互为因果,共同导致不良预后。从预防性研究看,许多研究集中于AF患者的卒中预防,但几乎没有研究关注在AF患者中HF的预测和预防。从治疗性研究看,药物治疗对AF与HF共存预后产生影响的证据非常有限,许多证据来自于观察性研究或者亚组分析的研究,或者有方法学缺陷的事后分析结果,需要谨慎解读。导管消融可降低HFrEF合并AF患者的死亡风险,然而对于HFpEF与AF并存的患者尚无研究证据。目前,亟需进行充分的头对头随机对照临床试验,以明确AF和HF之间复杂的相互关系,以期得到最佳预防与治疗措施。

Atrial fibrillation(AF) and heart failure(HF) commonly coexist.Both HF with preserved ejection fraction(HFpEF) and HF with reduced ejection fraction(HFrEF) have complex mutual cause-and-effect interactions in the development of AF,and their co-presence is associated with adverse outcomes.Currently,many clinical studies have focused more on stroke prevention instead of HF prevention.Despite advances in medical therapy in HF and AF,there is still uncertainty on the best management on the co-presence of HF and AF.Moreover,and most of evidence on co-presence were from retrospective observational studies,subgroup analyses or post hoc analysis with methodological limitation.In surgical treatment,catheter ablation can reduce the risk of all cause mortality in patients with AF with HFrEF,but research evidence of the coexistence of HFpEF and AF is still limited.At present,there is an urgent need for a full head-to-head randomized controlled clinical trials to clarify the optimal prevention and treatment in the complex co-presence of AF and HF.