心脏磁共振特征追踪技术对心房颤动患者经导管射频消融术后复发的预测价值

The prediction value of cardiac magnetic resonance feature tracking in patients with atrial fibrillation after radiofrequency catheter ablation

目的应用心脏磁共振特征追踪技术(FT-CMR)评价心房颤动(AF)患者左心房功能,探讨左心房功能指标对经导管消融术后复发的预测价值。方法回顾性筛选2016年10月—2019年10月首都医科大学附属北京安贞医院经导管射频消融治疗的AF患者74例,于术前进行心脏磁共振检查。根据有无AF复发分为维持窦性心律组51例和AF复发组23例。应用心脏后处理分析软件CVI42测量左心房心肌应变及应变率参数。比较2组患者的临床资料及左心房应变参数,使用多因素Logistic回归方法分析影响AF术后复发的因素。进行左心房应变及应变率参数的组间比较、组内相关系数(ICC)分析。结果与维持窦性心律组比较,复发组左心房储存功能(Es、SRs)、管道功能(Ee、SRe)参数绝对值及纵向峰值应变(PLAS)明显降低,差异具有统计学意义(t/P=2.418/0.018、2.471/0.016、2.239/0.028、2.484/0.015、2.466/0.016)。二元Logistic回归结果显示,女性和应变参数PLAS降低是影响AF患者术后复发的危险因素[OR(95%CI)=3.523(1.005~12.343)、1.085(1.011~1.163)]。左心房应变和应变率参数均有良好的观察者内一致性(ICC 0.83~0.98)和观察者间可重复性(ICC 0.81~0.95)。结论AF复发患者左心房储存功能受损明显,FT-CMR技术可检测AF患者左心房功能的改变,且可重复性高。女性及应变参数PLAS降低是影响AF射频消融术后复发的危险因素。

Objective Using cardiac magnetic resonance feature tracking(FT-CMR)to evaluate the left atrial function of atrial fibrillation(AF).The paper will discuss the predictive value of left atrial function index in recurrence after radiofrequency catheter ablation(RFA).Methods A total of 74 patients with atrial fibrillation who would undergo RFA from October 2016 to October 2019 in Beijing Anzhen Hospital Affiliated to Capital Medical University were retrospectively selected and underwent CMR examination before surgery.The average follow up of the postoperative is(11.3±3.5)months.According to AF recurrence,the patients were divided into the maintenance sinus rhythm group(51 cases)and the AF recurrence group(23 cases).FT-CMR parameters were detected by using offline cardiovascular analysis software cvi42.Compared the differences in clinical data and the left atrium strain and strain rate parameters of the two groups,the factors of the recurrence of the AF recurrence were predicted by Binary Logistic analysis.The correlation coefficient was analyzed in the group between the left atrial strain and strain rate parameters.Result Compared with the maintenance sinus rhythm group,the left atrial reservoir function(Es,SRs)and conduit function(Ee,SRe),PLAS of AF recurrence group were significantly impaired(t/P=2.418/0.018,2.471/0.016,2.239/0.028,2.484/0.015,2.466/0.016).With Binary Logistic analysis,female(OR=3.523,95%CI 1.005-12.343,P=0.049)and PLAS(OR=1.085,95%CI 1.011-1.163,P=0.023)were predictors of recurrence(all P<0.05).The left atrial strain and strain rate parameters all have good intra observer consistency(ICC 0.83-0.98)and good inter observer repeatability(ICC 0.81-0.95).Conclusion FT-CMR technique can detect the change of the left atrium function of atrial fibrillation patients with hign repeatability.The left atrial reservoir function of atrial fibrillation recurrence group was significantly impaired.Gender and reduced PLAS of strain parameter are risk factors for AF recurrence after RFA.