Clinical characteristics and long-term prognosis of initial patients with new onset different type of heart failure combined atrial fibrillation

doi:10.3969/j.issn.1004-583X.2022.06.004

Abstract

Abstract:

Objective This study investigated outcomes related to new onset different type of heart failure in patients with atrial fibrillation (AF). Methods This study was a retrospective observational study. The subjects were recruited from the People's Hospital of Xuancheng City from July 2017 to July 2020. All Patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with mid-range ejection fraction (HFmrEF) were initially diagnosed. According to the result of AF, the patients were divided into four groups, HFrEF with AF (n=41),HFrEF with non- AF (n=59), HFmrEF with AF (n=58), HFmrEF with non- AF (n=35). The clinical characteristics and clinical adverse events of the 4 groups were compared.Multivariate Cox regression was used to analyze the effect of HFmrEF and HFrEF patients with AF on clinical adverse events. Results A total of 193 patients were selected. The mean follow-up time was (28.87±11.13) months. Among the four groups, the difference was statistically significant in the gender, age, uric acid, N-terminal pro-B-type natriuretic peptide (NT-proBNP), Left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAD), left ventricular shortening score, CHA₂DS₂ - VASc score, New York heart association (NYHA), the utilization rate of β-blockers and diuretics, and the incidence of major adverse cardiovascular and cerebrovascular events (All P<0.05). Multiple Cox regression analysis shows that NYHA(HR=1.814,95%CI=1.051-3.131),NT-proBNP(HR=1.076,95%CI=1.033-1.120),CHA₂DS₂-VASc score(HR=1.375,95%CI=1.022-1.851),HFrEF with AF(HR=5.822,95%CI=1.699-19.955),HFmrEF with AF(HR=5.023,95%CI=1.565-16.118) were the influencing factors of main adverse cardiovascular and cerebrovascular events(All P<0.05). Kaplan-Meier analysis showed that the difference was a statistically significant in the incidence of long-term major adverse cardiovascular and cerebrovascular events among the four groups (χ²=12.432, P=0.006). Conclusion The initial patients with (HFrEF) or heart failure with mid-range ejection fraction (HFmrEF) combined AF were associated with increased risk of main adverse cardiovascular and cerebrovascular events.

Key words: heart failure with reduced ejection fraction, heart failure with mid-range ejection fraction, atrial fibrillation, outcome

CLC Number:

Zhang Jingshui, Xu Yanan, Wang Jun, Yang Yi, Jiang Haibing, Tang Long, Wang Xianping, Shao Mingliang. Clinical characteristics and long-term prognosis of initial patients with new onset different type of heart failure combined atrial fibrillation[J]. Clinical Focus, 2022, 37(6): 504-509.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.06.004

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I6/504

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References 20

[1]	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur J Heart Fail, 2016, 18(8):2129.
[2]	唐绪荣, 聂谦, 赵珏, 等. 射血分数中间值型心力衰竭的临床研究进展[J]. 心肺血管病杂志, 2020, 39(8): 1016-1019.
[3]	Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: Epidemiology, pathophysiology, and rationale for therapy[J] .Am J Cardiol, 2003, 91(6A):2D-8D.
[4]	Swedberg K, Olsson LG, Charlesworth A, et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: Results from COMET[J] .Eur Heart J, 2005, 26(13): 1303-1308. pmid: 15767288
[5]	Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: Treatment considerations for a dual epidemic[J] .Circulation, 2009, 119(18): 2516-2525. doi: 10.1161/CIRCULATIONAHA.108.821306 pmid: 19433768
[6]	Mogensen UM, Jhund PS, Abraham WT, et al. Type of atrial fibrillation and outcomes in patients with heart failure and reduced ejection fraction[J] .J Am Coll Cardiol, 2017, 70(20): 2490-2500. doi: S0735-1097(17)39778-4 pmid: 29145948
[7]	Dries DL, Exner DV, Gersh BJ, et al. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: A retrospective analysis of the SOLVD trials. Studies of Left Ventric[J]. J Am Coll Cardiol, 1998, 32(3):695-703. doi: 10.1016/s0735-1097(98)00297-6 pmid: 9741514
[8]	Ahmed MI, White M, Ekundayo OJ, et al. A history of atrial fibrillation and outcomes in chronic advanced systolic heart failure: A propensity-matched study[J]. Eur Heart J, 2009, 30(16):2029-2037. doi: 10.1093/eurheartj/ehp222 URL
[9]	Cheng M, Lu X, Huang J, et al. The prognostic significance of atrial fibrillation in heart failure with a preserved and reduced left ventricular function: Insights from a meta-analysis[J]. Eur J Heart Fail, 2014, 16(12):1317-1322. doi: 10.1002/ejhf.187 pmid: 25371247
[10]	Romero R, Gaytán JM, Aguirre A, et al. The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure[J] .Clin Res Cardiol, 2019, 108(6): 622-633. doi: 10.1007/s00392-018-1389-x URL
[11]	Hohendanner F, Heinzel FR, Blaschke F, et al. Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure[J] .Heart Fail Rev, 2018, 23(1): 27-36. doi: 10.1007/s10741-017-9657-9 pmid: 29038991
[12]	Lubitz SA, Moser C, Sullivan L, et al. Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community[J] .J Am Heart Assoc, 2013, 2(5): e000126. doi: 10.1161/JAHA.113.000126 URL
[13]	Shotan A, Garty M, Blondhein DS, et al. Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: Results from heart failure survey in Israel (HFSIS)[J]. Eur Heart J, 2010, 31(3): 309-317. doi: 10.1093/eurheartj/ehp422 URL
[14]	Cho Y, Oh IY, Park JJ, et al. Impact of successful restoration of sinus rhythm in patients with atrial fibrillation and acute heart failure: Results from the Korean Acute Heart Failure registry[J]. Cardiol J, 202229(3):472-480.
[15]	Cunningham JW, Vaduganathan M, Claggett BL, et al. Effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide in heart failure with preserved ejection fraction[J]. JACC Heart Fail, 2020, 8(5):372-381. doi: 10.1016/j.jchf.2020.03.002 URL
[16]	Savarese G, Orsini N, Hage C, et al. Associations with and prognostic and discriminatory role of N-terminal pro-B-type natriuretic peptide in heart failure with preserved versus mid-range versus reduced ejection fraction[J]. J Card Fail, 2018, 24(6):365-374. doi: 10.1016/j.cardfail.2018.03.010 URL
[17]	蒋璐, 龚国彪, 康小兰, 等. 重组人脑利钠肽对严重心力衰竭患者心肌纤维化标志物水平的影响[J]. 疑难病杂志, 2020, 19(10):1005-1008.
[18]	Shuvy M, Zwas DR, Keren A, et al. Value of the CHA₂DS₂-VASc score for predicting outcome in patients with heart failure[J] .ESC Heart Fail, 2020, 7(5):2553-2560.
[19]	Kajimoto K, Sato N. Investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry.Sex differences in new york heart association functional classification and survival in acute heart failure patients with preserved or reduced ejection fraction[J] .Can J Cardiol, 2020, 36(1): 30-36. doi: S0828-282X(19)31167-5 pmid: 31759787
[20]	Caraballo C, Desai NR, Mulder H, et al. Clinical implications of the new york heart association classification[J]. J Am Heart Assoc, 2019, 8(23): e014240. doi: 10.1161/JAHA.119.014240 URL

项目	Group 1(n=35)	Group 2(n=59)	Group 3(n=58)	Group 4(n=41)	F/Z/χ²值	P值
男性[例(%)]	18(51.4)	35(59.3)	22(37.9)	26(63.4)	8.008	0.046
年龄(岁)	73.94±9.24	70.31±11.66	76.86±8.17	72.34±10.06	4.448	0.005
高血压[例(%)]	20(57.1)	25(42.4)	26(44.8)	20(48.8)	2.112	0.549
糖尿病[例(%)]	6(17.1)	6(10.2)	4(6.9)	6(14.6)	2.828	0.419
目前吸烟[例(%)]	3(8.6)	11(18.6)	4(6.9)	3(7.3)	4.979	0.173
吸烟年数(年)	33.33±5.77	30.00±17.32	30.79±17.04	29.00±24.75	0.081	0.969
每天吸烟数量(支)	16.67±5.77	16.36±4.52	20.00±8.17	20.00±10.00	0.504	0.684
BMI(kg/m²)	21.71±4.06	21.52±3.30	21.30±3.19	21.76±3.29	0.183	0.908
冠心病[例(%)]	10(28.6)	14(23.7)	7(12.1)	6(14.6)	5.219	0.156
既往PCI[例(%)]	1(2.9)	3(5.1)	0(0.0)	0(0.0)	3.828	0.150
NYHA分级[例(%)]
Ⅱ	6(17.1)	13(22.0)	3(5.2)	2(4.9)
Ⅲ	20(57.1)	34(57.6)	38(65.5)	20(48.8)	16.320	0.012
Ⅳ	9(25.7)	12(20.3)	17(29.3)	19(46.3)
肌酐(μmol/L)	96.20(71.80, 136.00)	91.80(71.00, 112.90)	86.10(68.95, 102.70)	93.30(77.30, 112.05)	2.776	0.427
尿素(mmol/L)	9.08±4.26	8.22±3.78	7.86±4.02	8.52±4.67	0.645	0.587
尿酸(μmol/L)	398.31±110.07	444.93±141.67	431.98±156.79	492.74±155.28	2.740	0.045
葡萄糖(mmol/L)	5.75±1.72	5.29±1.47	5.45±1.77	5.38±1.71	0.557	0.644
NT-proBNP (ng/L)	7399.00 (3131.00, 13266.00)	7688.00 (4629.00, 13954.00)	4132.50 (2771.75, 7173.50)	7188 (4714.50.00, 14705.00)	18.899	<0.01
左心室舒张末内径(mm)	59.29±7.20	65.12±8.33	53.06±7.43	59.92±6.93	20.440	<0.01
LAD(mm)	41.13±5.02	45.80±6.34	45.89±6.79	47.82±9.69	5.240	0.002
LVEF (%)	44(42, 48)	31(27, 36)	46(42, 48)	32(28, 37)	144.410	<0.01
CO	6.10±1.77	6.18±2.07	4.97±1.83	5.92±1.85	1.074	0.365
FS	19.91±3.53	15.32±3.06	19.88±3.45	15.66±3.32	28.662	<0.01
CHA₂DS₂-VAS评分	3.23±0.77	3.00±1.17	3.29±1.04	3.34±1.13	1.096	0.352
用药[例(%)]
β受体阻滞剂	10(28.6)	25(42.4)	56(96.6)	39(95.1)	77.555	<0.01
ARB/ACEI	20(57.1)	25(42.4)	26(44.8)	20(48.8)	2.112	0.549
利尿剂	22(62.9)	57(96.6)	47(81.0)	41(100.0)	32.575	<0.01
MACCEs[例(%)]	4(11.4)	8(13.6)	18(31.0)^*#	14(34.1)^*#	10.667	0.014

项目	Group 1(n=35)	Group 2(n=59)	Group 3(n=58)	Group 4(n=41)	F/Z/χ²值	P值
男性[例(%)]	18(51.4)	35(59.3)	22(37.9)	26(63.4)	8.008	0.046
年龄(岁)	73.94±9.24	70.31±11.66	76.86±8.17	72.34±10.06	4.448	0.005
高血压[例(%)]	20(57.1)	25(42.4)	26(44.8)	20(48.8)	2.112	0.549
糖尿病[例(%)]	6(17.1)	6(10.2)	4(6.9)	6(14.6)	2.828	0.419
目前吸烟[例(%)]	3(8.6)	11(18.6)	4(6.9)	3(7.3)	4.979	0.173
吸烟年数(年)	33.33±5.77	30.00±17.32	30.79±17.04	29.00±24.75	0.081	0.969
每天吸烟数量(支)	16.67±5.77	16.36±4.52	20.00±8.17	20.00±10.00	0.504	0.684
BMI(kg/m²)	21.71±4.06	21.52±3.30	21.30±3.19	21.76±3.29	0.183	0.908
冠心病[例(%)]	10(28.6)	14(23.7)	7(12.1)	6(14.6)	5.219	0.156
既往PCI[例(%)]	1(2.9)	3(5.1)	0(0.0)	0(0.0)	3.828	0.150
NYHA分级[例(%)]
Ⅱ	6(17.1)	13(22.0)	3(5.2)	2(4.9)
Ⅲ	20(57.1)	34(57.6)	38(65.5)	20(48.8)	16.320	0.012
Ⅳ	9(25.7)	12(20.3)	17(29.3)	19(46.3)
肌酐(μmol/L)	96.20(71.80, 136.00)	91.80(71.00, 112.90)	86.10(68.95, 102.70)	93.30(77.30, 112.05)	2.776	0.427
尿素(mmol/L)	9.08±4.26	8.22±3.78	7.86±4.02	8.52±4.67	0.645	0.587
尿酸(μmol/L)	398.31±110.07	444.93±141.67	431.98±156.79	492.74±155.28	2.740	0.045
葡萄糖(mmol/L)	5.75±1.72	5.29±1.47	5.45±1.77	5.38±1.71	0.557	0.644
NT-proBNP (ng/L)	7399.00 (3131.00, 13266.00)	7688.00 (4629.00, 13954.00)	4132.50 (2771.75, 7173.50)	7188 (4714.50.00, 14705.00)	18.899	<0.01
左心室舒张末内径(mm)	59.29±7.20	65.12±8.33	53.06±7.43	59.92±6.93	20.440	<0.01
LAD(mm)	41.13±5.02	45.80±6.34	45.89±6.79	47.82±9.69	5.240	0.002
LVEF (%)	44(42, 48)	31(27, 36)	46(42, 48)	32(28, 37)	144.410	<0.01
CO	6.10±1.77	6.18±2.07	4.97±1.83	5.92±1.85	1.074	0.365
FS	19.91±3.53	15.32±3.06	19.88±3.45	15.66±3.32	28.662	<0.01
CHA₂DS₂-VAS评分	3.23±0.77	3.00±1.17	3.29±1.04	3.34±1.13	1.096	0.352
用药[例(%)]
β受体阻滞剂	10(28.6)	25(42.4)	56(96.6)	39(95.1)	77.555	<0.01
ARB/ACEI	20(57.1)	25(42.4)	26(44.8)	20(48.8)	2.112	0.549
利尿剂	22(62.9)	57(96.6)	47(81.0)	41(100.0)	32.575	<0.01
MACCEs[例(%)]	4(11.4)	8(13.6)	18(31.0)^*#	14(34.1)^*#	10.667	0.014

指标	单因素分析			多因素分析
指标	HR	95%CI	P	HR	95%CI	P
性别(女)	0.711	0.390-1.296	0.265
年龄(岁)	0.991	0.964-1.018	0.518
高血压	1.033	0.572-1.866	0.915
糖尿病	0.535	0.166-1.729	0.296
目前吸烟	1.062	0.419-2.695	0.899
BMI	1.013	0.931-1.103	0.758
冠心病	1.090	0.524-2.268	0.817
既往PCI	0.989	0.136-7.185	0.991
NYHA分级	2.023	1.229-3.330	0.006	1.814	1.051-3.131	0.033
肌酐(μmol/L)	1.037	1.003-1.072	0.035	1.036	0.993-1.081	0.105
尿酸(μmol/L)	1.001	0.999-1.003	0.540
NT-proBNP (ng/L)	1.036	1.001-1.072	0.046	1.076	1.033-1.120	<0.01
LVEDD(mm)	0.993	0.958-1.029	0.692
LAD(mm)	1.009	0.968-1.052	0.667
CO	0.892	0.651-1.222	0.476
FS	1.085	1.008-1.169	0.030	1.073	0.988-1.165	0.096
CHA₂DS₂-VASc评分	1.705	1.268-2.293	<0.01	1.375	1.022-1.851	0.036
β受体阻滞剂	1.641	0.829-3.248	0.155
ARB/ACEI	1.033	0.572-1.866	0.915
利尿剂	1.648	0.589-4.607	0.341
临床分组
Group2 vs Group1	1.207	0.363-4.007	0.759	1.910	0.536-6.810	0.318
Group3 vs Group1	3.199	1.082-9.457	0.035	5.023	1.565-16.118	0.007
Group4 vs Group1	3.818	1.256-11.603	0.018	5.822	1.699-19.955	0.005

指标	单因素分析			多因素分析
指标	HR	95%CI	P	HR	95%CI	P
性别(女)	0.711	0.390-1.296	0.265
年龄(岁)	0.991	0.964-1.018	0.518
高血压	1.033	0.572-1.866	0.915
糖尿病	0.535	0.166-1.729	0.296
目前吸烟	1.062	0.419-2.695	0.899
BMI	1.013	0.931-1.103	0.758
冠心病	1.090	0.524-2.268	0.817
既往PCI	0.989	0.136-7.185	0.991
NYHA分级	2.023	1.229-3.330	0.006	1.814	1.051-3.131	0.033
肌酐(μmol/L)	1.037	1.003-1.072	0.035	1.036	0.993-1.081	0.105
尿酸(μmol/L)	1.001	0.999-1.003	0.540
NT-proBNP (ng/L)	1.036	1.001-1.072	0.046	1.076	1.033-1.120	<0.01
LVEDD(mm)	0.993	0.958-1.029	0.692
LAD(mm)	1.009	0.968-1.052	0.667
CO	0.892	0.651-1.222	0.476
FS	1.085	1.008-1.169	0.030	1.073	0.988-1.165	0.096
CHA₂DS₂-VASc评分	1.705	1.268-2.293	<0.01	1.375	1.022-1.851	0.036
β受体阻滞剂	1.641	0.829-3.248	0.155
ARB/ACEI	1.033	0.572-1.866	0.915
利尿剂	1.648	0.589-4.607	0.341
临床分组
Group2 vs Group1	1.207	0.363-4.007	0.759	1.910	0.536-6.810	0.318
Group3 vs Group1	3.199	1.082-9.457	0.035	5.023	1.565-16.118	0.007
Group4 vs Group1	3.818	1.256-11.603	0.018	5.822	1.699-19.955	0.005