超声参数联合实验室标志物对老年非瓣膜性心房颤动患者射频消融术后复发的预测价值

Predictive value of ultrasound parameters combined with laboratory markers for recurrence of NVAF in elderly patients after RFCA

目的探讨老年非瓣膜性心房颤动(房颤)患者导管射频消融(RFCA)术后复发的相关危险因素。方法选取2019年1月至2021年3月于内蒙古医科大学附属医院心血管内科因非瓣膜性房颤行RFCA的老年患者83例,根据术后1年随访结果分为复发组24例和非复发组59例。收集所有入选者术前基本临床资料,检测N末端B型钠尿肽前体(NT-proBNP)与miR-21水平,并利用经胸超声心动图及经食管超声心动图获取左心房内径(LAD)、左心室舒张末期内径、LVEF和左心耳排空流速(LAAEV)。绘制ROC曲线评价不同指标及联合模型的预测效能。结果与非复发组比较,复发组LAD、miR-21、NT-proBNP水平明显升高,LAAEV明显降低,差异有统计学意义(P<0.01)。LAD(OR=1.304,95%CI:1.026~1.656,P=0.030)、LAAEV(OR=0.889,95%CI:0.804~0.982,P=0.021)和miR-21(OR=1.464,95%CI:1.143~1.877,P=0.003)是老年非瓣膜性房颤患者RFCA术后复发的独立预测因素。ROC曲线分析显示,LAD、LAAEV、miR-21预测老年非瓣膜性房颤患者RFCA术后复发的AUC分别为0.733(95%CI:0.606~0.860)、0.772(95%CI:0.663~0.880)、0.831(95%CI:0.719~0.944)。LAD+LAAEV+miR-21联合模型的AUC明显大于LAD、LAAEV、miR-21,差异有统计学意义(P<0.05)。结论LAD、LAAEV以及miR-21与老年非瓣膜性房颤患者RFCA术后复发明显相关,3项指标联合模型可以明显提高房颤术后复发的预测能力。

Objective To investigate the related risk factors of recurrence in elderly patients with non-valvular atrial fibrillation(NVAF)after radiofrequency catheter ablation(RFCA).Methods A total of 83 elderly NVAF patients who underwent RFCA in the cardiology department of our hospital from January 2019 to March 2021 were recruited in this study.According to the results of 1 year's follow-up after operation,they were divided into recurrent group(n=24)and non-recurrent group(n=59).The basic clinical data before operation were collected,and the levels of NTproBNP and miR-21 were measured.Left atrial diameter(LAD),left ventricular end diastolic diameter,left ventricular ejection fraction(LVEF)and left atrial appendage emptying velocity(LAAEV)were obtained by transthoracic echocardiography and transesophageal echocardiography.ROC curve was drawn to evaluate the predictive efficiency of different indexes and combined models.Results Compared with the non-recurrent group,the levels of LAD,miR-21 and NT-proBNP were significantly higher and LAAEV was obviously lower in the recurrent group(P<0.01).LAD(OR=1.304,95%CI:1.026-1.656,P=0.030),LAAEV(OR=0.889,95%CI:0.804-0.982,P=0.021)and miR-21(OR=1.464,95%CI:1.143-1.877,P=0.003)were independent predictors of recurrence after RFCA in the elderly NVAF patients.ROC curve analysis showed that the AUC values of LAD,LAAEV and miR-21 for predicting AF recurrence after RFCA were 0.733(95%CI:0.606-0.860),0.772(95%CI:0.663-0.880)and 0.831(95%CI:0.719-0.944),respectively.The AUC value of LAD+LAAEV+miR-21 combined model was significantly higher than that of LAD,LAAEV and miR-21 alone(P<0.05).Conclusion LAD,LAAEV and miR-21 are associated with AF recurrence after radiofrequency ablation in the elderly patients.The combined model of the 3 indexes can significantly improve the predictive efficiency of the recurrence of AF after operation.