Background: Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated tha t higher heart rates are unfavorable, since this may lead t...Background: Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated tha t higher heart rates are unfavorable, since this may lead to tachycardiomyopathy , but there are no data which have examined this. Methods and results: Seventy- seven patients with atrial fibrillation and advanced chronic heart failure, age 70±7 years, left-ventricular ejection fraction 0.23±0.08, 61%with ischemic e tiology were included. Patients were dichotomized according to the median heart rate(80 bpm) at inclusion(39 patients with “low”heart rate and 38 patients wit h “high”heart rate). At baseline, both patient groups were remarkably comparab le. After a mean follow-up of 3.3±0.9 years, mortality was comparable(62%vers us 55%, p=non-significant). An independent relation was found between lower he art rate and survival, in addition to absence of hypertension, digoxin use, and higher N-ANP, dopamine, and renin levels. Conclusion: In the present analysis, patients with atrial fibrillation and advanced chronic heart failure with higher heart rates are comparable to those with lower heart rates. Not higher heart ra tes at baseline but, on the contrary, lower heart rates seem associated with a w orse outcome.展开更多
Background: Atrial fibrillation(AF) is associated with an increased risk for cardiovascular disease. It is important to detect AF at an early stage and to search for new pathophysiological pathways to intervene. We hy...Background: Atrial fibrillation(AF) is associated with an increased risk for cardiovascular disease. It is important to detect AF at an early stage and to search for new pathophysiological pathways to intervene. We hypothesized that microalbuminuria and C-reactive protein(CRP), a marker of generalized vascular damage and inflammation, respectively, are associated with AF. Methods: Standard 12-lead electrocardiograms were recorded in 7546 subjects(mean age 49±13 years, 51%male). AF was defined according to Minnesota codes. The urinary albumin excretion rate was measured as the mean of two 24-h urine collections and microalbuminuria was defined as an albumin excretion rate between 30 and 300 mg per 24 h. High-sensitive CRP was dichotomized(low: three lowest quartiles, CRP< 2.87 mg/l vs. high: highest quartile, CRP >2.87 mg/l). Data are expressed as odds ratios(95%confidence intervals). Results: AF was present in 75(1.0%) subjects. In multivariate analysis, an age >60 years, the presence of ischemic heart disease, left ventricular hypertrophy, elevated CRP level(1.79 [1.07-2.97], p=0.03) and microalbuminuria(1.93 [1.10-3.37], p=0.02) were significantly associated with AF. Surprisingly, the combination of elevated CRP and the presence of microalbuminuria showed an even higher association with AF after adjusting for all cardiovascular risk factors(3.80 [1.89-7.63], p< 0.001). Conclusions: An elevated CRP level and microalbuminuria are associated with AF. Moreover, the combination of both indicates a fourfold higher association with the presence of AF in a population at large.展开更多
文摘Background: Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated tha t higher heart rates are unfavorable, since this may lead to tachycardiomyopathy , but there are no data which have examined this. Methods and results: Seventy- seven patients with atrial fibrillation and advanced chronic heart failure, age 70±7 years, left-ventricular ejection fraction 0.23±0.08, 61%with ischemic e tiology were included. Patients were dichotomized according to the median heart rate(80 bpm) at inclusion(39 patients with “low”heart rate and 38 patients wit h “high”heart rate). At baseline, both patient groups were remarkably comparab le. After a mean follow-up of 3.3±0.9 years, mortality was comparable(62%vers us 55%, p=non-significant). An independent relation was found between lower he art rate and survival, in addition to absence of hypertension, digoxin use, and higher N-ANP, dopamine, and renin levels. Conclusion: In the present analysis, patients with atrial fibrillation and advanced chronic heart failure with higher heart rates are comparable to those with lower heart rates. Not higher heart ra tes at baseline but, on the contrary, lower heart rates seem associated with a w orse outcome.
文摘Background: Atrial fibrillation(AF) is associated with an increased risk for cardiovascular disease. It is important to detect AF at an early stage and to search for new pathophysiological pathways to intervene. We hypothesized that microalbuminuria and C-reactive protein(CRP), a marker of generalized vascular damage and inflammation, respectively, are associated with AF. Methods: Standard 12-lead electrocardiograms were recorded in 7546 subjects(mean age 49±13 years, 51%male). AF was defined according to Minnesota codes. The urinary albumin excretion rate was measured as the mean of two 24-h urine collections and microalbuminuria was defined as an albumin excretion rate between 30 and 300 mg per 24 h. High-sensitive CRP was dichotomized(low: three lowest quartiles, CRP< 2.87 mg/l vs. high: highest quartile, CRP >2.87 mg/l). Data are expressed as odds ratios(95%confidence intervals). Results: AF was present in 75(1.0%) subjects. In multivariate analysis, an age >60 years, the presence of ischemic heart disease, left ventricular hypertrophy, elevated CRP level(1.79 [1.07-2.97], p=0.03) and microalbuminuria(1.93 [1.10-3.37], p=0.02) were significantly associated with AF. Surprisingly, the combination of elevated CRP and the presence of microalbuminuria showed an even higher association with AF after adjusting for all cardiovascular risk factors(3.80 [1.89-7.63], p< 0.001). Conclusions: An elevated CRP level and microalbuminuria are associated with AF. Moreover, the combination of both indicates a fourfold higher association with the presence of AF in a population at large.
