CAAP-AF评分和APPLE评分对心房颤动合并心力衰竭患者导管消融术后复发的预测价值

Predictive value of CAAP-AF scores and APPLE scores on recurrence after catheter ablation of patients with atrial fi brillation and heart failure

目的探讨CAAP-AF评分和APPLE评分对心房颤动(房颤)合并心力衰竭患者导管消融术后复发的预测价值。方法回顾性分析2017年—2018年在广东省人民医院行导管消融治疗的130例房颤合并心力衰竭患者。根据术后3个月是否发生持续的至少30 s的任何房性心律失常,将患者分为复发组和无复发组。记录所有患者的CAAP-AF评分、APPLE评分、术后12个月内的动态心电图及其他一般资料,对结果进行相应的统计学分析。结果随访12个月发现,共29例(22.3%)患者术后复发。复发组与无复发组的CAAP-AF评分[5(1,9)分比5(1,11)分]及APPLE评分[1(0,5)分比1(0,5)分]比较,差异均无统计学意义(均P>0.05)。生存分析显示,导管消融术后复发与风险评分增加均无显著相关性(Log-rank均P>0.05)。进一步行受试者工作特征曲线分析显示,两种评分预测导管消融术后复发的能力较低,其曲线下面积分别为0.51和0.53。logistic多因素回归分析显示,仅心肌病(OR 4.347,P=0.022)是房颤合并心力衰竭患者导管消融术后复发的独立危险因素。结论CAAP-AF评分和APPLE评分用于房颤合并心力衰竭患者预测导管消融术后复发的能力有限,尚需要结合其他指标来进一步评估。

Objective To assess the predictive value of the CAAP-atrial fi brillation(AF)and APPLE risk scores on recurrence after catheter ablation of patients with atrial fibrillation and heart failure.Methods One hundred and thirty patients with atrial fibrillation and heart failure who received catheter ablation in Guangdong Provincial People’s Hospital from 2017 to 2018 were retrospectively analyzed.According to whether there was a recurrence of atrial arrhythmia for more than 30 s after 3 months postablation,the patients were divided into the recurrent group and non-recurrent group.The CAAP-AF risk score,APPLE risk score,Holter-ECG within 12 months and other baseline characteristics were collected from each individual and analyzed statistically.Results During a follow-up period of 12 months,29(22.3%)patients experienced recurrent AF after ablation.There was no statistical diff erence in CAAP-AF[5(1,9)points vs.5(1,11)points]or APPLE scores[1(0,5)points vs.1(0,5)points]between the two groups(all P>0.05).Kaplan-Meier survival curves showed that AF recurrence was not associated with increased CAAPAF or APPLE scores(Log-rank all P>0.05).Further receiver operating characteristic(ROC)curve analysis showed that the two scores showed poor performance in predicting recurrence after ablation,and their AUC was 0.51 and 0.53,respectively.Multi-logistic regression analysis indicated that cardiomyopathy(OR 4.347,P=0.022)was the only independent risk factor for the recurrence after ablation in AF patients with heart failure.Conclusions The performance of CAAP-AF or APPLE risk scores for predicting postoperative recurrence in patients with AF and heart failure is poor.It needs to be further evaluated in combination with other indicators.