斑点追踪超声心动图参数在预测非瓣膜性心房颤动患者导管消融后心房颤动复发中的实用性。

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2024-10-05 eCollection Date: 2024-01-01 DOI:10.2147/TCRM.S486056

Decai Zeng, Linyan Li, Shuai Chang, Xiaofeng Zhang, Yanfen Zhong, Yongzhi Cai, Tongtong Huang, Ji Wu

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Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%).Results: The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all P < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. 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引用次数: 0

摘要

背景：尽管导管消融术（CA）作为非瓣膜性心房颤动（NVAF）的治疗方法效果显著，但许多患者在消融术后仍会出现心房颤动（AF）复发。本研究旨在评估斑点追踪超声心动图（STE）参数对消融术后房颤复发的预测价值：方法：前瞻性招募了 380 名 2020 年 1 月至 2023 年 3 月在广西医科大学第一附属医院接受 CA 治疗的 NVAF 患者。平均年龄为（59.4±10.8）岁，72.1%为男性，包括150例（39.5%）持续性房颤患者和230例（60.5%）阵发性房颤患者。STE 用于评估 48 小时内 CA 前的左心房（LA）基线功能。在中位随访 9 个月（四分位间范围为 4-17 个月）期间，132 名患者（34.7%）出现房颤复发：复发组的左心室射血分数、LA储腔应变（LASr）和导管应变（LAScd）均低于非复发组，但LA僵硬度高于非复发组（P均<0.05）。多变量 Cox 回归确定 LA 硬度和 LASr 为独立风险因素。时间依赖性 ROC 分析显示，LA 僵硬度（AUC 0.768，95% CI 0.705-0.831）和 LASr（AUC 0.755，95% CI 0.691-0.820）在预测 1 年房颤复发方面优于其他风险因素。对于导管消融术后 2 年的房颤复发，LA 僵硬度（AUC 0.866，95% CI 0.804-0.928）和 LASr（AUC 0.860，95% CI 0.800-0.920）也显示出更优越的预测性能。Kaplan-Meier曲线显示，LA僵硬度>0.55和LASr≤24.3%的患者房颤复发率有显著差异（对数秩P<0.01）：结论：使用 STE 评估 LA 功能有助于对 NVAF 患者房颤复发风险进行分层，并指导后续管理。LASr和LA僵硬度是预测NVAF患者CA术后房颤复发的独立指标，可能优于其他形态学参数。

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The Utility of Speckle Tracking Echocardiographic Parameters in Predicting Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Non-Valvular Atrial Fibrillation.

Background: Despite the efficacy of catheter ablation (CA) as a treatment for non-valvular atrial fibrillation (NVAF), many patients still experience atrial fibrillation (AF) recurrence after CA. This study aimed to evaluate the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-ablation.

Methods: A total of 380 NVAF patients treated with CA at the First Affiliated Hospital of Guangxi Medical University from January 2020 to March 2023 were prospectively recruited. The mean age was 59.4 ± 10.8 years, and 72.1% were male, including 150 patients (39.5%) with persistent AF and 230 patients (60.5%) with paroxysmal AF. STE was used to evaluate baseline left atrial (LA) function before CA within 48h. Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%).

Results: The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all P < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. Kaplan-Meier curves showed a significant difference in AF recurrence rate for patients with LA stiffness > 0.55 and LASr ≤ 24.3% (Log rank P < 0.01).

Conclusion: Evaluation of LA function using STE assists in stratifying the risk of AF recurrence in NVAF patients and guiding follow-up management. LASr and LA stiffness are independent predictors of AF recurrence following CA in NVAF patients, and potentially outperforming other morphological parameters.

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.