左房脂肪灰度值与胸腔镜外科射频消融治疗心房颤动预后的相关性

The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation

目的分析心外膜脂肪灰度值与胸腔镜外科射频消融术治疗心房颤动(房颤)预后的相关性。方法回顾性分析2017~2018年在阜外医院行胸腔镜外科射频消融97例患者临床资料,其中男75例、女22例,平均年龄(57.8±9.4)岁。左房增强CT计算左房脂肪体积和平均灰度,根据左房脂肪组织的平均灰度将患者分为高、中、低灰度三组。患者于术后3个月、6个月、12个月随访,随访终点为窦性心律恢复率。采用生存分析方法分析心外膜脂肪增强CT特征与预后的相关性。结果校正了患者的体重指数、体表面积、性别、左房舒张末期内径后,回归分析显示,左房增强CT脂肪灰度与房颤类型相关(OR=0.30,95%CI 0.12~0.79,P=0.014)。多因素Cox回归分析显示,左房CT脂肪灰度值可预测胸腔镜外科射频消融术后房颤复发(OR=0.92,95%CI 0.85~0.99,P=0.027)。Kaplan-Meier曲线显示,不同左房脂肪组织灰度值患者术后房颤复发率差异有统计学意义(P=0.011),左房脂肪增强CT灰度值越低,远期房颤复发率越高。结论左房脂肪增强CT灰度值可以有效预测胸腔镜外科射频消融术后房颤复发。

Objective To analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation(AF)treated by thoracoscopic radiofrequency ablation.Methods The clinical data of 97 patients,including 75 males and 22 females with an average age of 57.8±9.4 years,who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively.The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT.According to the average gray scale of left atrial fat tissue,the patients were divided into three groups:a high gray scale group,a medium gray scale group and a low gray scale group.The patients were followed up at 3,6 and 12 months after operation.The end point of follow-up was the recovery rate of sinus rhythm.Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis.Results After adjustment of body mass index,body surface area,gender and left atrial end diastolic diameter,regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF(OR=0.30,95%CI 0.12-0.79,P=0.014).Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation(OR=0.92,95%CI 0.85-0.99).The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups(P=0.011).The lower left atrial fat enhanced CT gray scale was,the higher long-term recurrence rate of AF was.Conclusion The gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.