JAHA:心房颤动消融后内皮功能障碍与预后的关系

2023-05-29 MedSci原创 MedSci原创 发表于上海

心房颤动(AF)是最常见的心律失常,房颤患者ED患病率高。评估内皮功能可以对房颤消融后心血管事件进行风险分层。

心房颤动(AF)是最常见的心律失常,由于发病率和死亡率的增加,需要药物治疗。据报道,导管消融可降低房颤患者发生血管事件的风险,如卒中、心力衰竭和死亡。然而,尽管房颤消融后的潜在疾病和合并症以及房颤相关并发症的发生率很高,但对房颤消融后结果进行风险分层的方法有限。CHA2DS2-VASc评分是房颤患者缺血性卒卒中险分层的标准工具,据报道,它是房颤消融后心血管预后的有力预测指标,包括复发和其他心血管事件。

内皮功能障碍(ED),通过外周血管反应性充血指数(RHI)来评估,是动脉硬化的综合指标,也是心血管事件的预后指标。最近的文章讨论了内皮功能与AF之间的密切关系。特别是,通过血流介导的舒张来评估的内皮功能已被发现与新发房颤以及房颤患者的心血管事件相关。然而,ED作为房颤消融后的预后标志物补充到CHA2DS2‐VASc评分的效用尚不清楚。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究旨在探讨房颤消融患者ED与5年心血管事件之间的关系。

研究人员对首次房颤消融的患者进行了一项前瞻性队列研究,消融前通过外周血管反应性充血指数(RHI)评估其内皮功能。我们将ED定义为RHI<2.1。心血管事件包括卒中、需要住院治疗的心力衰竭、需要治疗的动脉硬化性疾病、静脉血栓形成、室性心律失常或心源性猝死。研究人员比较了有ED和无ED的房颤消融后5年心血管事件发生率。

在1040名入选患者中,829名(79.7%)患有ED,RHI值与CHA2DS2-VASc评分相关(P=0.004)。ED患者的5年心血管事件发生率高于无ED患者(98例[11.8%] vs 13例[6.2%];P=0.014)。研究人员发现ED是房颤消融后心血管事件的独立预测因子(风险比[HR]为1.91[95%CI为1.04-3.50];P=0.036),CHA2DS2-VASc评分≥2(女性≥3)(HR为3.68 [95%CI为1.89-7.15];P<0.001)。

由此可见,房颤患者ED患病率高。评估内皮功能可以对房颤消融后心血管事件进行风险分层。

原始出处:

Keisuke Okawa,et al.Relationship Between Endothelial Dysfunction and the Outcomes After Atrial Fibrillation Ablation.JAHA.2023.https://www.ahajournals.org/doi/full/10.1161/JAHA.122.028482

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2139953, encodeId=4b5b213995309, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e8a8165412, createdName=ms1000001511798936, createdTime=Tue May 30 19:48:00 CST 2023, time=2023-05-30, status=1, ipAttribution=云南省), GetPortalCommentsPageByObjectIdResponse(id=2139823, encodeId=dce72139823d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Tue May 30 05:36:11 CST 2023, time=2023-05-30, status=1, ipAttribution=宁夏), GetPortalCommentsPageByObjectIdResponse(id=2139764, encodeId=f7f82139e64ba, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Mon May 29 21:10:41 CST 2023, time=2023-05-29, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2139800, encodeId=b44e2139800a7, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon May 29 23:16:47 CST 2023, time=2023-05-29, status=1, ipAttribution=浙江省)]
    2023-05-30 ms1000001511798936 来自云南省

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2139953, encodeId=4b5b213995309, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e8a8165412, createdName=ms1000001511798936, createdTime=Tue May 30 19:48:00 CST 2023, time=2023-05-30, status=1, ipAttribution=云南省), GetPortalCommentsPageByObjectIdResponse(id=2139823, encodeId=dce72139823d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Tue May 30 05:36:11 CST 2023, time=2023-05-30, status=1, ipAttribution=宁夏), GetPortalCommentsPageByObjectIdResponse(id=2139764, encodeId=f7f82139e64ba, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Mon May 29 21:10:41 CST 2023, time=2023-05-29, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2139800, encodeId=b44e2139800a7, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon May 29 23:16:47 CST 2023, time=2023-05-29, status=1, ipAttribution=浙江省)]
    2023-05-30 1581f8c42cm 来自宁夏

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    2023-05-29 医鸣惊人 来自山西省

    认真学习了

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  4. [GetPortalCommentsPageByObjectIdResponse(id=2139953, encodeId=4b5b213995309, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e8a8165412, createdName=ms1000001511798936, createdTime=Tue May 30 19:48:00 CST 2023, time=2023-05-30, status=1, ipAttribution=云南省), GetPortalCommentsPageByObjectIdResponse(id=2139823, encodeId=dce72139823d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Tue May 30 05:36:11 CST 2023, time=2023-05-30, status=1, ipAttribution=宁夏), GetPortalCommentsPageByObjectIdResponse(id=2139764, encodeId=f7f82139e64ba, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Mon May 29 21:10:41 CST 2023, time=2023-05-29, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2139800, encodeId=b44e2139800a7, content=好文章,值得一读。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Mon May 29 23:16:47 CST 2023, time=2023-05-29, status=1, ipAttribution=浙江省)]
    2023-05-29 yangchou 来自浙江省

    好文章,值得一读。

    0

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