Including hemoglobin levels and female sex provide the additional predictive value of the APPLE score for atrial fibrillation recurrence post-catheter ablation

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology Pub Date : 2025-03-01 DOI:10.1016/j.hjc.2023.12.003

Wenchao Huang , Huaxin Sun , Yan Luo , Yan Tang, Shiqiang Xiong, Yu Long, Hanxiong Liu

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Abstract

Objective

We probed whether the addition of hemoglobin (HGB) or the female sex (SEX) as variables would provide additional prognostic value to the APPLE score.

Methods

An optimized APPLE score was used to evaluate the AF recurrence risk in the consecutive populations with AF post-catheter ablation including the development (n = 562) and validation (n = 239) cohorts.

Results

In the populations of AF recurrence, most patients were female sex (103/164, 62.8%), and had the lower HGB levels. After adjusting for the APPLE score, HGB level (Odds Ratio [OR], 0.828; 95% Confidence Interval [CI], 0.749–0.915; P < 0.001) and female sex (OR, 1.596; 95% CI, 1.140-2.235; P = 0.006) independently predicted AF recurrence. Adjusting the APPLE score by HGB variable improved its predictive ability for AF recurrence (C-statistic value from 0.675 to 0.711, P = 0.010), which also increased the C-indexes in the external validation (from 0.653 to 0.725, p = 0.023). The female sex variable also enhanced the C-statistic value of the APPLE score for AF recurrence at both development and external validation (C-indices from 0.675 to 0.691, P = 0.004; C-indices from 0.653 to 0.704, p = 0.037, respectively). Decision curve analysis showed that the HGB plus APPLE score was better than the SEX plus APPLE score in predicting AF recurrence in two following AF populations.

Conclusion

The inclusion of HGB level and female sex variables improved the predictability and clinical usefulness of adjusted APPLE score. Adjustment of the APPLE score by HGB levels may provide better predictive value than inclusion of the female sex variable.

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包括血红蛋白水平和女性性别在内的 APPLE 评分对导管消融术后心房颤动复发具有额外的预测价值

方法使用优化的APPLE评分评估导管消融术后房颤连续人群的房颤复发风险，包括开发队列（n=562）和验证队列（n=239）。结果在房颤复发人群中，大多数患者为女性（103/164，62.8%），HGB水平较低。调整 APPLE 评分后，HGB 水平（Odds Ratio [OR]，0.828；95% Confidence Interval [CI]，0.749-0.915；P<0.001）和女性性别（OR，1.596；95% CI，1.140-2.235；P=0.006）可独立预测房颤复发。用 HGB 变量调整 APPLE 评分可提高其对房颤复发的预测能力（C 统计量值从 0.675 升至 0.711，P=0.010），这也提高了外部验证的 C 指数（从 0.653 升至 0.725，P=0.023）。在开发和外部验证中，女性性别变量也提高了 APPLE 评分对房颤复发的 C 统计量值（C 指数分别从 0.675 升至 0.691，P=0.004；C 指数从 0.653 升至 0.704，P=0.037）。决策曲线分析表明，在以下两种房颤人群中，HGB 加 APPLE 评分在预测房颤复发方面优于 SEX 加 APPLE 评分。根据 HGB 水平调整 APPLE 评分可能比纳入女性性别变量具有更好的预测价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hellenic Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

7.30%

发文量

审稿时长

56 days

期刊介绍： The Hellenic Journal of Cardiology (International Edition, ISSN 1109-9666) is the official journal of the Hellenic Society of Cardiology and aims to publish high-quality articles on all aspects of cardiovascular medicine. A primary goal is to publish in each issue a number of original articles related to clinical and basic research. Many of these will be accompanied by invited editorial comments. Hot topics, such as molecular cardiology, and innovative cardiac imaging and electrophysiological mapping techniques, will appear frequently in the journal in the form of invited expert articles or special reports. The Editorial Committee also attaches great importance to subjects related to continuing medical education, the implementation of guidelines and cost effectiveness in cardiology.