血清CCN5与房颤患者左房低电压面积的相关性研究

目的:探讨房颤患者血清CCN5水平是否可以预测左房低电压面积(LVZ)的大小。方法:选取2023年6月到2024年1月于烟台毓璜顶医院就诊的窦性心律患者(对照组) 79例以及首次接受心脏射频消融术的房颤患者(房颤组)114例。收集一般资料、生化、心电图、心脏超声等临床资料。按术中行基质电压标测所得的LVZ是否大于6%将患者分为A组(LVZ Objective: To explore whether the serum CCN5 levels associated with atrial fibrosis can predict LVZ in patients with atrial fibrillation. Methods: In this study, 79 patients with sinus rhythm (control group) and 114 patients with atrial fibrillation (atrial fibrillation group) who received radiofrequency cardiac ablation for the first time in Yantai Yuhuangding Hospital between June 2023 and January 2024 were enrolled. General data, biochemistry, electrocardiogram, cardiac ultrasound and other clinical data were collected. Left atrial stroma voltage mapping was performed in patients with atrial fibrillation and LVZ area ratio was calculated. Patients were divided into group A (LVZ < 6%) and group B (LVZ ≥ 6%) according to whether LVZ was greater than 6%. The expression level of CCN5 in peripheral blood was measured by enzyme-linked immunosorbent assay. T test was used to compare the CCN5 expression level between the control group and the atrial fibrillation group. Pearson or Spearman correlation analysis was used to explore the correlation between CCN5 and clinical data. Binary Logistic regression analysis was used to determine the risk factors affecting the LVZ, and receiver operating characteristic (ROC) analysis was down to determine the cut-off value of CCN5 to predict LVZ. Results: The level of CCN5 in patients with atrial fibrillation was lower than in control group (32.43 ± 6.15 vs. 25.46 ± 4.97, P < 0.001). For atrial fibrillation patients with LVZ < 6%, blood CCN5 expression levels were lower in patients with LVZ ≥ 6% (30.10 ± 6.75 vs. 24.75 ± 3.49, P < 0.001). In patients with atrial fibrillation, CCN5 was negatively correlated with BNP level, left atrial diameter and left atrial low-voltage area ratio (P < 0.05). Logistic regression analysis suggested that blood CCN5 level was an independent risk factor for LVZ. ROC curve showed that in patients with atrial fibrillation, the optimal blood concentration of CCN5 to predict LVZ ≥ 6% was 27.22 ng/ml, sensitivity was 0.707, specificity was 0.773, and area under the curve was 0.785 [P < 0.001, CI: (0.696, 0.873)]. Conclusion: Serum CCN5 can independently predict the proportion of left atrial low-voltage area in patients with atrial fibrillation.

三维斑点追踪技术评估非瓣膜性心房颤动患者左房低电压区对左房结构及功能的影响

目的应用三维斑点追踪技术(3D-STI)评估非瓣膜性心房颤动(以下简称房颤)患者不同程度左房低电压区(LVA)对左房结构及功能的影响。方法选取我院拟行射频消融术的非瓣膜性房颤患者66例,术前均行经胸超声心动图检查获得左房收缩末期前后径、左右径、上下径和左室舒张末期内径、左室射血分数、二尖瓣口舒张早期峰值血流速度与二尖瓣环峰值运动速度比值(E/e’);3D-STI获得左房储器期应变(LASr)、管道期应变(LAScd)、泵功能期应变(LASct)及左房射血分数(LAEF)。进行射频消融术时应用三维电解剖标测技术获得LVA,根据LVA面积占左房总面积的百分比定义LVA程度,将患者分为无LVA患者组(Ⅰ组)29例、LVA程度<10%组(Ⅱ组)26例、LVA程度≥10%组(Ⅲ组)11例,比较各组临床资料和超声心动图参数的差异;分析左房应变参数与LVA的相关性。结果Ⅲ组陈旧性脑梗死或一过性脑缺血、持续性房颤占比及CHA_(2)DS_(2)-VASc评分均高于Ⅰ组、Ⅱ组,差异均有统计学意义(均P<0.05)。Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组E/e’>14者占比比较,差异均有统计学意义(均P<0.05);其余常规超声心动图参数比较,差异均无统计学意义。Ⅲ组LASr、LAScd、LASct、LAEF均低于Ⅰ组、Ⅱ组,差异均有统计学意义(均P<0.05)。相关性分析显示,LASr、LAScd、LASct均与LVA呈负相关(r=-0.538、-0.448、-0.501,均P<0.05)。结论当LVA达到10%时,房颤患者左房结构虽未发生改变,但其功能已经减低;应用3D-STI可以早期发现非瓣膜性房颤患者LVA程度对左房功能的影响。

左房低电压与心房颤动相关性的研究进展

心肌纤维化与心房颤动(房颤)可相互影响,互为因果,电解剖标测系统显示的左房低电压提示左房纤维化。近年来大量研究表明左房低电压可显著增加房颤术后的复发风险。研究显示在阵发性房颤患者中,肺静脉隔离附加左房低电压区消融是否更有效存在争议;在持续性房颤患者中,肺静脉隔离附加左房低电压区消融可显著降低房颤的复发风险。此外,左房低电压也可提示房颤患者有脑梗死病史及沉默性脑梗死的发生。现针对近年来左房低电压与房颤相关性的研究进展做一综述。

老年左房前壁自发性瘢痕相关心房扑动的电生理特征及分析

目的:探讨老年患者左房前壁自发性瘢痕相关心房扑动(房扑)的电生理特征及消融预后。方法:选择2018年1月至2020年1月复旦大学附属闵行医院收治的左房前壁自发性瘢痕相关的老年房扑患者5例,行电生理检查及三维电解剖指导下的射频消融术,平均年龄(76.6±10.5)岁,均为持续性房扑。术中通过激动标测、拖带标测以及电压标测等技术,确定房扑的诊断、机制、关键峡部及其与左房前壁自发瘢痕和低电压区的关系。结果:5例患者左房扩大,其中3例升主动脉内径增宽。5例患者均在左房前壁标测到低电压区和瘢痕区,多位于左房前壁靠近升主动脉压迹的部位。房扑均为折返性,关键峡部位于局部低电压区,消融后均成功终止房扑。其中1例因左房内径较大,同时行环肺静脉电隔离;1例复发,行二次消融。平均随访(15.6±4.2)个月后无复发。结论:左房前壁自发性瘢痕是部分老年患者左房房扑的发病基质,房扑的机制为折返性;左房内径扩大、升主动脉内径增宽可能与左房前壁瘢痕区和低电压区的形成相关。

心房颤动患者血清尿酸水平与左房纤维化程度的相关性研究

目的:研究心房颤动患者血清尿酸(SUA)水平与左房纤维化程度的相关性。方法:回顾性分析因心房颤动首次接受导管射频消融手术治疗的患者,在进行双侧肺静脉电隔离后、窦性心律时绘制左房电压图,若局部双极信号<0.5 mV,则定义为低电压区(LVAS)。根据LVAS面积占左心房总面积的范围,将患者分为<10%组(57例)与≥10%组(51例)。比较两组间年龄、性别、BMI、糖化血红蛋白(HbA1c)、白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(PLT)、甘油三酯(TG)、总胆固醇(TC)、SUA、左心房直径(LAD)等指标之间是否存在差异。采用多因素logistic回归分析影响心房纤维化的独立危险因素。绘制受试者工作特征(ROC)曲线,观察SUA及其他相关指标预测左房纤维化程度的价值。结果:≥10%组持续性心房颤动比例、SUA、LAD、TG、吸烟史、饮酒史患者所占比例均高于<10%组,且差异具有统计学意义(均P<0.05)。Pearson相关分析显示,SUA和左房纤维化程度呈正相关(r=0.327,P=0.001)。二元logistic回归分析示,SUA(OR=1.01,95%CI:1.003~1.016,P=0.004)、持续性心房颤动(OR=11.041,95%CI:2.479~49.166,P=0.002)、LAD(OR=1.146,95%CI:1.016~1.293,P=0.026)是心房纤维化的独立危险因素。ROC曲线显示,SUA截点值为396.5μmol/L时,预测左房纤维化的敏感度为0.392,特异度为0.965(AUC=0.702,95%CI:0.602~0.803,P<0.001);LAD截点值为37.5 mm时,预测左房纤维化的敏感度为0.706,特异度为0.754(AUC=0.779,95%CI:0.690~0.869,P<0.001)。结论:心房颤动患者SUA水平是左房纤维化的独立危险因素,对预测心房纤维化程度具有一定参考价值。