低左心耳峰值排空速度对阵发性心房颤动导管消融术后复发的预测价值

Predictive value of Low left atrial appendage peak emptying flow velocity on paroxysmal atrial fibrillation recurrence after radiofrequency catheter ablation

目的探讨术前基线左心耳峰值排空速度(left atrial appendage peak emptying flow velocity,LAAeV)在预测射频导管消融术(radiofrequency catheter ablation,RFCA)后阵发性心房颤动(paroxysmal atrial fibrillation,PAF)复发中的价值。方法回顾性分析190例于2017年6月至2019年7月在苏州大学附属第一医院心内科行RFCA的PAF患者的临床资料。患者消融前通过经食管超声心动图获得LAAeV并随访12个月,记录患者复发情况。用多元Cox回归分析校正PAF复发的危险因素,评估LAAeV对术后PAF复发的影响,并用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估LAAeV对术后PAF复发的预测效率。结果37例(19.47%)复发(复发组),153例(80.53%)未复发(未复发组)。复发组患者的LAAeV显著低于未复发组,差异有统计学意义[35.20(29.50~49.00)cm/s vs.60.00(46.00~75.00)cm/s,P<0.001]。多元COX回归分析结果显示,高左心房内径(HR=1.066,95%CI:1.001~1.136,P=0.046)是预测PAF复发的独立危险因素。高LAAeV(HR=0.954,95%CI:0.932~0.977,P<0.001)是预防术后PAF复发的独立保护性因素。根据ROC分析,LAAeV预测术后PAF复发的最佳截断值是42.05 cm/s,准确度为0.802(95%CI:0.716~0.888,P<0.001)、敏感度为67.6%、特异度为85.0%。结论术前较低LAAeV与术后PAF复发独立相关,是预测RFCA后PAF 1年复发的独立危险因素。

Objectives To investigate the value of preoperative baseline left atrial appendage peak emptying flow velocity(LAAeV)in predicting recurrence of paroxysmal atrial fibrillation(PAF)after radiofrequency catheter ablation(RFCA).Methods Clinical data of 190 inpatients with PAF who underwent RFCA between June 2017 and July 2019 in the First Affiliated Hospital of Soochow University were retrospectively analyzed in this study.The LAAeV was obtained by transesophageal echocardiography before ablation,and the recurrence of PAF was recorded during the follow up period of 12 months.Multivariate Cox regression analysis was used to adjust the risk factors affecting PAF recurrence and to evaluate the effect of LAAeV on PAF recurrence after RFCA.The predictive efficiency of LAAeV on PAF postoperative recurrence was evaluated by the receiver operating characteristic(ROC)curve.Results Thirty seven(19.47%)PAF patients had recurrence(recurrence group),and 153(80.53%)patients had no recurrence(non-recurrence group).The level of LAAeV in patients with recurrent PAF was significantly lower than that in patients without recurrent PAF[35.20(29.50-49.00)cm/s vs.60.00(46.00-75.00)cm/s,P<0.001].Multivariate Cox regression analyses revealed that high left atrial diameter(LAD)level(HR=1.066,95%CI:1.001-1.136,P=0.046)was a significant risk factor that could predicte PAF recurrence,and high LAAeV level(HR=0.954,95%CI:0.932-0.977,P<0.001)was an independent protective factor against recurrenc after RFCA.According to the ROC curve analysis,the optimal cut off value of LAAeV for predictingp PAF recurrence was≥40.05 cm/s with a specificity of 85.0%and a sensitivity of 67.6%.Moreover,the area under the curve spanned 0.802(95%CI:0.716-0.888,P<0.001).Conclusions Preoperativelow LAAeV level independently associates with postoperative PAF recurrence,and is an independent risk factor for predicting 1-year recurrence of PAF after RFCA.