应用心脏磁共振成像技术预测心房颤动患者消融术后早期复发概率的可行性研究

The feasibility study to predict probability of early recurrence after ablation in patients with atrial fibrillation by cardiac magnetic resonance imaging

目的探讨应用钆对比剂延迟增强-心脏磁共振成像(late-gadolinium enhanced cardiac magnetic resonance imaging,LGE-CMRI)检查预测心房颤动(atrial fibrillation,AF)患者射频消融术后AF早期复发概率的可行性。方法收集2014年7月至2017年12月期间福建省立医院心内科住院行环肺静脉射频消融术(circumferential pulmonary vein ablation,CPVA)治疗的38例AF患者为研究对象,其中男性22例,女性16例,术后3个月均接受LGE-CMRI检查,测量各个肺静脉口瘢痕范围,计算环肺静脉瘢痕占比。以术后3个月根据普通心电图或24h动态心电图检查结果提示AF是否复发分为复发组(10例)和未复发组(28例),比较两组间环肺静脉瘢痕占比及各临床特征资料的差异,并进行Logistic回归分析,绘制受试者操作特征曲线(receiver operator characteristic curve,ROC curve,ROC曲线)进行分析。结果复发组环肺静脉瘢痕占比为(60.96±4.69)%,低于未复发组[(82.54±6.71)%,t=3.475,P<0.05];两组间其他临床特征资料,包括年龄、性别、术前AF类型、心脑血管疾病(高血压、糖尿病、冠心病)、左心房内径,差异均无统计学意义(P>0.05)。通过二元Logistic回归分析,环肺静脉瘢痕占比与早期AF复发呈负相关(回归系数β=﹣0.177,P=0.01,OR=0.838,95%CI:0.732~0.958);环肺静脉瘢痕占比曲线下面积为0.857,P=0.003,最佳临界点为70.75%,敏感度为85.7%,特异度为87.5%。结论环肺静脉消融术后行LGE-CMRI检查预测其AF早期复发概率是可行的,术后环肺静脉瘢痕占比值大于70.75%时,AF早期复发可能性小。

Objective To investigate the feasibility of late-gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMRI) to predict the probability of early recurrence after radiofrequency ablation in patients with atrial fibrillation.Method Thirty-eight patients (22 males and 16 females) were enrolled in the study,who had nonvalvular atrial fibrillation (AF) and underwent circumferential pulmonary vein ablation (CPVA) in Fujian Provincial Hospital between July 2014 and December 2017.All patients underwent LGE-CMRI 3 months after surgery.The scar extent of each pulmonary vein orifices was measured and the proportion of scar was calculated.They were divided into recurrent group and non-recurrent group based on the results of ordinary electrocardiogram or 24-hour dynamic electrocardiogram 3 months after surgery.The proportion of annular pulmonary vein scar and the difference of clinical characteristics between the two groups were compared,and logistic regression and ROC analysis were performed.Result The proportion of annular pulmonary vein scar in recurrent group was significantly lower than that in non-recurrent group[(60.96±4.69) % vs (82.54±6.71) %,t=3.475,P<0.05].There were no significant differences in other clinical characteristics between the two groups,including age,gender,preoperative AF type,cardiovascular and cerebrovascular diseases (hypertension,diabetes,coronary heart disease),and left atrial diameter (P>0.05).Binary logistic regression analysis showed that the proportion of annular pulmonary vein scar was negatively correlated with early AF recurrence (regression coefficient β=﹣0.177,P=0.01,OR=0.838,95%CI:0.732-0.958).ROC analysis showed that the optimal cutoff point was 70.75% for proportion of annular pulmonary vein scar (the area under the curve 0.857,P=0.003),and the sensitivity was 85.7%,and the specificity was 87.5%.Conclusion It is feasible to perform LGE-CMRI after CPVA to predict the early recurrence probability of AF.When the postoperative annular pulmonary vein scar proportion is greater than 70.75%,the early recurrence probability of AF is low.