双心房应变预测阵发性心房颤动导管消融术后复发

Bilateral atrial strain predicted recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation

目的探讨超声心动图评价的左、右心房应变对阵发性心房颤动(房颤)患者导管消融术后复发的影响。方法纳入2014—2018年因阵发性房颤首次行导管消融术的患者,收集基本信息、病史、术前超声心动图、手术信息及术后1年房颤是否复发等信息。比较复发组与非复发组基线临床资料和超声心动图参数,采用LASSO回归筛选与术后1年复发相关的超声心动图参数,将筛选出的参数与临床资料共同纳入多因素Logistic回归模型,探讨心房功能参数与导管消融术后复发的关系,并在左心房容积正常和扩大的病例中进行亚组分析。结果240例患者纳入分析,1年内复发组80例,未复发组160例。复发组患者与未复发组比较,左心房容积指数增大[(42.88±16.83)ml/m^(2)比(38.92±11.37)ml/m^(2),P=0.047],左心房总体应变降低[21.70(11.16,31.84)比27.91(18.28,36.70),P=0.008],右心房总体应变降低[26.93(17.32,40.31)比34.20(22.65,50.45),P=0.020]。用LASSO回归筛选出左心房和右心房总体应变两个参数纳入多因素Logistic回归模型,分析显示左心房总体应变是术后1年复发的独立危险因素(OR 0.97,95%CI 0.95~1.00,P=0.024),右心房总体应变对复发无影响。左心房容积指数正常和扩大的亚组中,左心房总体应变的水平不影响复发的风险,交互作用(P=0.245);在左心房容积指数≤34 ml/m^(2)的患者中,右心房总体应变是复发的独立危险因素,应变值较高者复发率较低;而在左心房容积指数>34 ml/m^(2)的患者中,右心房总体应变不影响复发的风险,交互作用(P=0.016)。结论左心房总体应变是阵发性房颤导管消融术后1年复发的独立危险因素;在左心房容积指数正常的患者中,右心房总体应变是复发的独立危险因素。

Objective To investigate the effect of left and right atrial strain evaluated by echocardiography on recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation.Methods Patients with paroxysmal AF who underwent radiofrequency ablation for the first time in our hospital from 2014 to 2018 were enrolled.The baseline information,prior medical history,preoperative echocardiography,information of catheter ablation procedure and whether AF recurred 1 year after ablation were collected.The baseline characteristics and echocardiographic parameters of recurrence group and non-recurrence group were compared.The echocardiographic parameters related to recurrence 1 year after operation were screened by LASSO regression.The screened parameters and clinical data were included in the multivariate Logistic regression model to explore the relationship between atrial function parameters and recurrence after catheter ablation.Subgroup analysis was done in subjects with normal or enlarged left atrium.Results A total of 240 patients were included in the analysis,including 80 cases recurred within 1 year and 160 cases not.Compared with the non-recurrence group,patients in the recurrence group had higher left atrial volume index[(42.88±16.83)ml/m^(2)vs.(38.92±11.37)ml/m^(2),P=0.047],lower left atrial global strain[21.70(11.16,31.84)vs.27.91(18.28,36.70),P=0.008]and right atrial global strain[26.93(17.32,40.31)vs.34.20(22.65,50.45),P=0.020].LASSO regression showed that left atrial global strain and right atrial global strain were correlated with recurrence after catheter ablation,which were included in the multivariate regression model.Multivariate logistic regression analysis showed that left atrium global strain was an independent risk factor of recurrence one year after operation(OR 0.97,95%CI 0.95-1.00,P=0.024),while right atrium global strain did not impact recurrence.In subgroup analysis of patients with normal or increased left atrial volume index,the P for interaction was 0.016.Conclusions Left atrium global strain is an independent risk factor of 1 year recurrence after catheter ablation of paroxysmal AF,in patients with normal left atrial volume,the overall strain of the right atrium is an independent risk factor of recurrence.