Circulationg:房颤诊疗存在重大疏漏!不能仅以房颤发作或终止作为评价标准,要重视房颤负荷

2018-04-17 文韬 中国循环杂志

昨日,Circulation杂志在线发表科学声明,指出目前临床多根据房颤类型进行相应的研究,包括阵发性与非阵发性、持续性或永久性房颤,推荐使用危险评分(CHA2DS2-VASc)进行抗凝治疗。但这存在重大疏漏:如果仅以有房颤或无房颤来描述太片面!今后要考虑房颤负荷问题。

昨日,Circulation杂志在线发表科学声明,指出目前临床多根据房颤类型进行相应的研究,包括阵发性与非阵发性、持续性或永久性房颤,推荐使用危险评分(CHA2DS2-VASc)进行抗凝治疗。但这存在重大疏漏:如果仅以有房颤或无房颤来描述太片面!今后要考虑房颤负荷问题。

比如:房颤负担与卒中风险之间的关系不清楚,是否不同房颤负担的人抗凝方案都一样?其次,新发房颤的患者生活质量更差,而房颤负担较高的人生活质量不一定较低,射频消融治疗房颤是否就能改善生活质量?等等。

该声明要点如下:

1.房颤负荷可以通过监测期持续时间最长,房颤发作次数来定义,也可能更全面地由监测期间房颤发作时间的比例来表示。

2.有证据表明持续性房颤患者发生脑卒中风险高于阵发性房颤患者,但尚无研究关注房颤负担与卒中风险之间的关系;短暂房颤发作(<5至6分钟)对脑卒中影响仍然未知。

3.房颤负荷与认知功能之间关系如何不清楚。

4.与阵发性房颤相比,非阵发性房颤与心力衰竭患病率和发生率较高以及死亡风险较高相关。

5. 房颤负担较高者不一定生活质量低;新发房颤的患者生活质量更差。降低房颤负担不一定可改善生活质量。

6. 针对动脉粥样硬化风险的管理方案,包括体重减轻和维持健康体重对减少房颤负担有效。

7.未来的研究应包括那些侧重于确认房颤负担的定义和观察手段,确定房颤负担导致脑卒中风险增加及抗凝治疗的阈值,以及房颤负担和中风的关联,以及监测技术的发展。

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    2018-04-19 huagfeg
  2. [GetPortalCommentsPageByObjectIdResponse(id=1444360, encodeId=09981444360c9, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Thu Apr 19 03:43:00 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540295, encodeId=72581540295ae, content=<a href='/topic/show?id=a1a8914e051' target=_blank style='color:#2F92EE;'>#评价标准#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91470, encryptionId=a1a8914e051, topicName=评价标准)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fa213200151, createdName=xqptu, createdTime=Thu Apr 19 03:43:00 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306671, encodeId=956a3066e1bb, content=不错.学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Tue Apr 17 13:23:21 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306662, encodeId=ebd630666203, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Apr 17 12:52:16 CST 2018, time=2018-04-17, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1444360, encodeId=09981444360c9, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Thu Apr 19 03:43:00 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540295, encodeId=72581540295ae, content=<a href='/topic/show?id=a1a8914e051' target=_blank style='color:#2F92EE;'>#评价标准#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91470, encryptionId=a1a8914e051, topicName=评价标准)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fa213200151, createdName=xqptu, createdTime=Thu Apr 19 03:43:00 CST 2018, time=2018-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306671, encodeId=956a3066e1bb, content=不错.学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Tue Apr 17 13:23:21 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306662, encodeId=ebd630666203, content=谢谢分享学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Apr 17 12:52:16 CST 2018, time=2018-04-17, status=1, ipAttribution=)]
    2018-04-17 虈亣靌

    不错.学习了.谢谢分享

    0

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    2018-04-17 清风拂面

    谢谢分享学习

    0

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