Endothelial dysfunction (ED), a well-established risk marker of cardiovascular events, is associated with heart failure (HF) and atrial fibrillation (AF). Its relationship with cardiovascular events in patients with HF undergoing AF ablation remains unclear. We aimed to elucidate the association between ED and the outcomes after AF ablation in patients with HF. This prospective cohort study included patients with HF who underwent an endothelial function assessment using the peripheral vascular reactive hyperemia index (RHI) before first-time AF ablation. We defined AF recurrence according to the following types: the conventional form (AF≥30 seconds) and persistent form (requiring cardioversion). An RHI<2.1 indicated ED. Those with and without ED were compared in terms of the 3-year incidence of AF recurrence and cardiovascular events after AF ablation. Among 421 patients with HF (69 ± 9 years and 38% females), 343 (81.5%) had ED. Although the incidence of the conventional form of AF recurrence was similar between the groups, that of the persistent form was significantly higher in the ED group (25.7% vs. 15.3%, log-rank P = 0.028). The ED group also had a significantly higher rate of cardiovascular events (14.8% vs. 3.6%, log-rank P = 0.028). Pre-procedural ED was identified as an independent predictor of a persistent form of AF recurrence (adjusted hazard ratio [HR] 2.31, 95% confidence interval [CI] 1.05–5.07, P = 0.037) and that of cardiovascular events (adjusted HR 4.21, 95% CI 1.02–17.5, P = 0.048), respectively. The endothelial function assessment enabled the risk stratification of clinically problematic outcomes after AF ablation in patients with HF.

中文翻译：

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接受房颤消融的心力衰竭患者根据内皮功能进行术前分层

内皮功能障碍 (ED) 是公认的心血管事件风险标志物，与心力衰竭 (HF) 和心房颤动 (AF) 相关。其与接受房颤消融的心力衰竭患者心血管事件的关系仍不清楚。我们的目的是阐明 ED 与 HF 患者房颤消融后结果之间的关联。这项前瞻性队列研究纳入了在首次 AF 消融前使用外周血管反应性充血指数 (RHI) 进行内皮功能评估的 HF 患者。我们根据以下类型定义房颤复发：常规型（房颤≥30秒）和持续型（需要复律）。RHI<2.1 表示 ED。比较患有和不患有 ED 的患者 3 年 AF 复发率和 AF 消融后心血管事件的发生率。在 421 名 HF 患者（69 ± 9 岁，38% 女性）中，343 名 (81.5%) 患有 ED。尽管各组之间传统型 AF 复发的发生率相似，但 ED 组中持续型 AF 复发的发生率显着较高（25.7% vs. 15.3%，对数秩 P = 0.028）。ED 组的心血管事件发生率也显着较高（14.8% vs. 3.6%，对数秩 P = 0.028）。术前 ED 被确定为持续性 AF 复发（调整后风险比 [HR] 2.31，95% 置信区间 [CI] 1.05–5.07，P = 0.037）和心血管事件（调整后 HR 4.21）的独立预测因素，95% CI 1.02–17.5，P = 0.048）。内皮功能评估能够对心力衰竭患者房颤消融后临床问题结果进行风险分层。