双多普勒技术评价心房颤动患者舒张功能对经导管射频消融术后晚期复发的预测价值及危险分层

The value of diastolic function parameters in predicting atrial fibrillation late recurrence after transcatheter radiofre-quency ablation by dual gate Doppler

目的 探讨双多普勒技术评估心房颤动(简称房颤)患者的舒张功能参数对经导管射频消融(RFCA)术后晚期复发的预测价值,并根据危险因素构建Nomogram模型对患者进行危险分层。方法 纳入133例行房颤RFCA患者,根据房颤有无晚期复发分为复发组及未复发组。所有患者于RFCA术前7天内行超声心动图检查。采用双多普勒法同步获取同一心动周期舒张早期二尖瓣口血流峰值速度(E)、瓣环室间隔(S)及侧壁(L)位点峰值速度e′(S)、e′(L)的比值E/e′(S)、E/e′(L)及均值E/e′(M);同步获取二尖瓣E与血流播散速度Vp的比值E/Vp。随机选取20例记录双多普勒法和传统法测量E/e′、E/Vp的消耗时间。受试者工作特征曲线(ROC)分析舒张功能参数对房颤晚期复发的预测价值。单因素及多因素Logistic回归分析房颤晚期复发的危险因素并构建Nomogram模型。结果 剔除手术未成功4例,失访6例,最终入选123例。未复发组65例,复发组58例。(1)与未复发组比较,复发组年龄、持续性房颤患者及高血压患者比例、左房容积指数、E/e′(L)、E/e′(S)、E/e′(M)、E/Vp、三尖瓣反流峰值速度>2.8 m/s患者比例增加(P均<0.05)。(2)ROC曲线显示E/e′(S)、E/e′(L)、E/e′(M)、E/Vp预测RFCA术后房颤晚期复发的曲线下面积分别为0.742、0.678、0.720、0.711。(3)双多普勒技术获取E/e′、E/Vp在采集图像、测量数据及总流程三个方面均较传统法耗时更少(P均<0.05)。(4)Logistic回归分析显示年龄、左房容积指数(LAVI)和E/e′(S)是预测房颤晚期复发的独立危险因素,基于这三个参数构建的Nomogram模型预测精确度较好,预测RFCA术后5年房颤复发的曲线下面积为0.791。结论 双多普勒技术评估E/e′(S)是RFCA术后房颤晚期复发的独立危险因素,与年龄、LAVI共同构建Nomogram模型预测术后5年复发精确度较好。

Objective To evaluate diastolic function parameters by dual gate Doppler of patients with atrial fibrilla-tion(AF)after radiofrequency catheter ablation(RFCA)and to establish a Nomogram model for risk stratification.Methods 133 patients with AF were retrospectively analyzed.According to whether there was late recurrence af-ter RFCA,they were divided into recurrent group and non-recurrent group.All patients underwent echocardiography within 7 days before RFCA.With dual gate Doppler,transmitral flow peak velocity(E)and mitral annular septal or lateral peak velocity e'(S),e'(L)in early diastolic were measured simultaneously in the same cardiac cycle,then E/e'(S),E/e'(L)and the mean value E/e'(M)were automatically calculated.The ratio E/Vp of mitral valve peak E and mitral valve blood diffusion velocity Vp was obtained simultaneously.The consumption time of E/e'and E/Vp measured by dual gate Doppler and traditional method were recorded in 20 randomly selected patients.Receiver oper-ating characteristic curve(ROC)showed the value of diastolic function parameters in predicting AF late recurrence.