DR-FLASH 评分联合左房心外膜脂肪对非瓣膜性心房颤动左房低电压的预测价值

Predictive value of DR-FLASH score combined epicardial adipose tissue surrounding left atrium for left atrial low-voltage in patients with non-valvular atrial fibrillation

目的探讨DR-FLASH评分和左房心外膜脂肪(LA-EAT)体积的相关性及二者联合预测非瓣膜性心房颤动(简称房颤)左房低电压区域(LVZ)的价值。方法连续纳入2019年9月至2021年4月徐州医科大学附属医院心血管内科首次接受导管射频消融治疗的非瓣膜性房颤患者246例,所有患者均接受肺静脉计算机断层扫描血管造影(CTA),并测量LA-EAT体积。根据患者入院情况计算DR-FLASH评分。术前进行肺静脉CTA扫描,计算测量LA-EAT体积。在术中窦性心律下,进行左房高密度电压标测,根据有无低电压(双极电压<0.5 mV)将患者分为LVZ组和无LVZ组。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验、χ^(2)检验及方差分析。采用Spearman相关性分析确定DR-FLASH评分与LA-EAT体积之间的相关性。采用受试者工作特征(ROC)曲线分析DR-FLASH评分、LA-EAT体积及其联合预测LVZ发生的价值。结果最终纳入患者246例,平均年龄(60.8±10.6)岁,其中56例(22.8%)患者出现至少1个LVZ。相关性分析显示DR-FLASH评分与LA-EAT体积呈正相关(r=0.439;P<0.001)。采用多因素分析显示DR-FLASH评分(OR=1.824,95%CI 1.390~2.394;P<0.001)和LA-EAT体积(OR=1.048,95%CI 1.013~1.085;P=0.007)是左房LVZ的独立危险因素。结合ROC曲线,LA-EAT体积、DR-FLASH评分、LA-EAT与DR-FLASH评分的ROC曲线下面积分别为0.712、0.750、0.796。结论DR-FLASH评分与LA-EAT体积呈正相关,DR-FLASH评分和LA-EAT体积均为非瓣膜性房颤左房LVZ的独立预测因子。二者联合可提高对非瓣膜性房颤左房LVZ的发生预测价值。

Objective To investigate the correlation between DR-FLASH score and epicardial adipose tissue(EAT)volume around the left atrium(LA),and explore the predictive value of their combination for left atrial low voltage zone(LVZ)in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 268 NVAF patients who received radiofrequency catheter ablation for first time in Department of Cardiovascular Diseases,Affiliated Hospital of Xuzhou Medical University from September 2019 to April 2121 were consecutively recruited in this single-center retrospective clinical observation study.All patients underwent CTA scanning of pulmonary vein preoperatively,and then the volume of LA-EAT was measured.DR-FLASH score were calculated after admission.During the operation,the high-density voltage mapping of the LA was performed under sinus rhythm,and the patients were divided into LVZ group and non-LVZ group according to LVZ existence(bipolar voltage<0.5 mV as low voltage area).SPSS statistics 24.0 was used for statistical analysis.Intergroup comparison was performed using student′s t test,U test or Chi-square test depending on data type.Spearman correlation analysis was employed to determine the correlation between DR-FLASH score and LA-EAT volume.Receiver operating characteristic(ROC)curve was plotted to analyze the value of DR-FLASH score,LA-EAT volume and their combination to predict LVZ occurrence.Results In the subjected 246 patients,their average age was(60.8±10.6)years,and at least one LVZ was found in 56 patients(22.8%).The correlation analysis showed that the DR-FLASH score was positively correlated with LA-EAT volume(r=0.439;P<0.001).Multivariate analysis revealed that DR-FLASH score(OR=1.824,95%CI 1.390-2.394;P<0.001)and LA-EAT(OR=1.048,95%CI 1.013-1.085;P=0.007)were independent risk factors for LVZ after radiofrequency catheter ablation.The area under the ROC curve was 0.712,0.750 and 0.796,respectively for LA-EAT volume,DR-FLASH score,and their combination.Conclusion For NVAF patients,their DR-FLASH score is positively correlated with LA-EAT volume.The two indicators are independent predictors of left atrial LVZ in them.Their combination can improve the predictive value of left atrial LVZ in NVAF patients with non-valvular atrial fibrillation.