引用本文:杜春雨,胡立群,李红旗.节律控制与心率控制治疗对合并房颤的射血分数保留心衰患者的预后效果比较[J].中国临床新医学,2022,15(4):310-314.
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节律控制与心率控制治疗对合并房颤的射血分数保留心衰患者的预后效果比较
杜春雨,胡立群,李红旗
230001 合肥,安徽医科大学附属省立医院老年医学科
摘要:
[摘要] 目的 比较节律控制与心率控制治疗对合并心房颤动(AF)的射血分数保留的心力衰竭(HFpEF)患者的预后效果。方法 回顾性收集2017年1月至2019年9月安徽医科大学附属省立医院收治的150例合并AF的HFpEF患者的临床资料。根据患者治疗意愿分为节律控制组(接受节律控制治疗方案,75例)和心率控制组(接受心率控制治疗方案,75例)。比较两组在随访24个月内的临床预后情况(结局指标包括全因死亡、心血管事件死亡和因心力衰竭住院)。比较两组治疗前及治疗12个月后氨基末端B型利钠肽前体(NT-proBNP)、左心室射血分数(LVEF)和肺动脉收缩压(PASP)。结果 在随访时间内,节律控制组有3例(4.00%)全因死亡者,心率控制组有9例(12.00%),两组差异无统计学意义(HR=0.309,P=0.119)。节律控制组有3例(4.00%)心血管事件死亡者,心率控制组有6例(8.00%),两组差异无统计学意义(HR=0.443,P=0.280)。节律控制组有5例(6.67%)因心力衰竭住院者,心率控制组有19例(25.33%),两组差异有统计学意义(HR=0.296,P=0.001)。在治疗12个月后,节律控制组的NT-proBNP和PASP水平较治疗前显著降低(P<0.05)。节律控制组NT-proBNP和PASP水平低于心率控制组,差异有统计学意义(P<0.05)。结论 相较于心率控制治疗,节律控制治疗可降低合并AF的HFpEF患者因心力衰竭入院的风险,但在全因死亡和心血管事件死亡方面两组预后差异不显著。
关键词:  射血分数保留的心力衰竭  心房颤动  射频消融  预后
DOI:10.3969/j.issn.1674-3806.2022.04.06
分类号:R 541.7
基金项目:安徽省自然科学基金项目(编号:1808085MH281)
Comparison of prognostic effects of rhythm control and heart rate control therapies in heart failure with preserved ejection fraction patients complicated with atrial fibrillation
DU Chun-yu, HU Li-qun, LI Hong-qi
Department of Geriatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
Abstract:
[Abstract] Objective To compare the prognostic effects of rhythm control and heart rate control therapies in heart failure with preserved ejection fraction(HFpEF) patients complicated with atrial fibrillation(AF). Methods The clinical data of 150 HFpEF patients complicated with AF admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2017 to September 2019 were retrospectively collected. The patients were divided into rhythm control group(receiving rhythm control therapy protocol, 75 cases) and heart rate control group(receiving heart rate control therapy protocol, 75 cases) according to their treatment intentions. The clinical prognoses(including all-cause death, cardiovascular death and hospitalization for heart failure) within 24 months of follow-up were compared between the two groups. The levels of amino-terminal pro-B-type natriuretic peptide precursor(NT-proBNP), left ventricular ejection fraction(LVEF) and pulmonary artery systolic pressure(PASP) were compared between the two groups before treatment and after 12 months of treatment. Results During the follow-up period, there were 3 cases(4.00%) of all-cause death in the rhythm control group, and 9 cases(12.00%) in the heart rate control group, with no significant difference between the two groups(HR=0.309, P=0.119). There were 3 cases(4.00%) in the rhythm control group who died of cardiovascular events, and 6 cases(8.00%) in the heart rate control group, with no significant difference between the two groups(HR=0.443, P=0.280). There were 5 cases(6.67%) who were hospitalized due to heart failure in the rhythm control group, and 19 cases(25.33%) in the heart rate control group, and the difference was statistically significant(HR=0.296, P=0.001). After 12 months of treatment, the levels of NT-proBNP and PASP in the rhythm control group were significantly lower than those before treatment(P<0.05). The levels of NT-proBNP, and PASP in the rhythm control group were lower than those in the heart rate control group, and the differences were statistically significant(P<0.05). Conclusion Compared with heart rate control therapy, rhythm control therapy can reduce the risk of hospitalization for heart failure in HFpEF patients complicated with AF, but the prognosis of all-cause death and the prognosis of cardiovascular death were not significantly different between the two groups.
Key words:  Heart failure with preserved ejection fraction(HFpEF)  Atrial fibrillation(AF)  Radiofrequency ablation  Prognosis