左心房与肺静脉容积比预测导管消融术后心房颤动复发

Left atrial volume/pulmonary vein volume for predicting recurrence of atrial fibrillation after catheter ablation

目的观察左心房容积(LAV)与肺静脉容积(PVV)比(LAV/PVV)预测导管消融术后心房颤动(AF)复发的价值。方法纳入95例接受导管消融术治疗的AF患者,根据术后随访1年内有无AF复发将其分别归入复发组(n=23)与未复发组(n=72)。采用2种方法(方法1,对各支肺静脉均渲染至距肺静脉开口部后2 cm;方法2,对各支肺静脉均渲染至肺静脉分叉后1 cm)基于心脏CT血管成像(CTA)测量左肺上静脉容积(LSPVV)、左肺下静脉容积(LIPVV)、右肺上静脉容积(RSPVV)及右肺下静脉容积(RIPVV),计算LAV及PVV;比较2种方法测值,评估LAV/PVV预测导管消融术后AF复发的价值。结果方法1、2所测LIPVV差异有统计学意义(P<0.05)。根据单因素分析结果,性别、年龄、体质量指数(BMI)、心力衰竭、LAV及LAV/PVV均为导管消融术后AF复发的危险因素;多因素分析结果显示,仅LAV/PVV为AF复发的危险因素。以8.27为方法1所获LAV/PVV的最佳截断值,其预测导管消融术后AF复发的曲线下面积(AUC)、敏感度及特异度分别为0.774、78.26%及70.83%;以9.02为方法2所获LAV/PVV的最佳截断值,其AUC、敏感度及特异度分别为0.691、56.52%及80.56%;以方法1所测量LAV/PVV预测导管消融术后AF复发的AUC高于方法2(P=0.018)。结论LAV/PVV可用于预测经导管消融术后AF复发,且以方法1所获LAV/PVV的预测价值更高。

Objective To observe the value of left atrial volume(LAA)/pulmonary vein volume(PVV)for predicting recurrence after catheter ablation in patients with atrial fibrillation(AF).Methods Totally 95 patients with AF who underwent catheter ablation were enrolled and divided into recurrent group(n=23)or non-recurrent group(n=72)according to AF recurred or not within 1 year after treatment.Based on cardiac CT angiography(CTA),left superior PVV(LSPVV),left inferior PVV(LIPVV),right superior PVV(RSPVV)and right inferior PVV(RIPVV)were measured using 2 methods(method 1,rendering each pulmonary vein to 2 cm behind the opening of the pulmonary vein;method 2,rendering each pulmonary vein to 1 cm after the bifurcation of the pulmonary vein),and LAV and PVV were calculated.The results were compared between methods,and the value of LAV/PVV for predicting recurrence of AF after catheter ablation was explored.Results Significant difference of LIPVV was found between measured method 1 and 2(P<0.05).Univariate analysis showed that sex,age,body mass index(BMI),heart failure,LAV and LAV/PVV were all risk factors of AF recurrence after catheter ablation,while multivariate analysis showed that only LAV/PVV was the risk factor.Taken 8.27 as the best cut-off value of LAV/PVV obtained with method 1,the area under the curve(AUC),sensitivity and specificity for predicting AF recurrence after catheter ablation was 0.774,78.26%and 70.83%,respectively.Taken 9.02 as the best cut-off value of LAV/PVV obtained with method 2,the AUC,sensitivity and specificity was 0.691,56.52%and 80.56%,respectively,and AUC of LAV/PVV obtained with method 1 was higher than that with method 2(P=0.018).Conclusion LAV/PVV could be used to predict AF recurrence after catheter ablation,and the value of LAV/PVV obtained with method 1 was better than with method 2.