沙库巴曲缬沙坦对持续性心房颤动导管消融术后临床疗效的影响:基于倾向性评分的单中心队列研究  

Effect of sacubitril/valsartan on clinical outcomes in patients with persistent atrial fibrillation undergoing catheter ablation:a single-center cohort study using propensity score matching

作　　者：梁晓芳[1] 李文华[1] 宋艳斌[1] 薛社亮[1] 王娟 凤伟祥 徐波[1] LIANG Xiaofang;LI Wenhua;SONG Yanbin;XUE Sheliang;WANG Juan;FENG Weixiang;XU Bo(Department of Cardiology,Wujin Hospital Affiliated with Jiangsu University,the Wujin Clinical College of Xuzhou Medical University,Changzhou,Jiangsu,213007,China)

机构地区：[1]江苏大学附属武进医院心内科徐州医科大学武进临床学院,江苏常州213017

出　　处：《临床心血管病杂志》2023年第9期699-706,共8页Journal of Clinical Cardiology

基　　金：江苏大学医教协同创新基金(No:JDYY2023077、JDYY2023076);常州市科技发展计划[No:(社会发展)CE20205004]。

摘　　要：目的:探讨沙库巴曲缬沙坦对持续性心房颤动(房颤)导管消融术后中远期预后的影响。方法:回顾性分析我院2019年1月—2022年11月因持续性房颤行导管消融术的患者210例,分为沙库巴曲缬沙坦组(ARNI组,93例)和ACEI/ARB组(117例)。采用1∶1倾向性匹配评分,比较匹配后两组手术相关参数(手术时间、术式、单圈隔离率、左心房基质、手术前后左心房脉冲压、平均左心房压)、手术并发症、复合终点事件和左心功能指标的差异。结果:倾向性评分后ARNI组和ACEI/ARB组共有72对匹配成功,两组手术时间、单圈隔离率、电复律率、手术前后左心房脉冲压、平均左心房压和术后并发症比较均差异无统计学意义。与ACEI/ARB组相比,ARNI组术后6个月的房颤复发率显著降低(25.00%vs 11.11%,P=0.048),心力衰竭加重比例明显减少(11.11%vs 2.78%,P=0.044);两组心血管死亡率和再住院率比较差异无统计学意义。亚组分析中,基质标测显示,两组存在低电压区域比例比较差异无统计学意义(65.28%vs 72.22%);与ACEI/ARB组相比,ARNI组存在左心房基质不良的患者6个月房颤复发率显著降低(33.33%vs 12.00%,P=0.017)。6个月左心功能和生化指标随访发现,与ACEI/ARB组相比,ARNI组左心房直径(LAD)显著降低[(43.08±6.54) mm vs (40.71±4.50) mm,P=0.017],N末端脑钠肽前体(NT-proBNP)水平显著降低[333.00(121.00,870.00) pg/mL vs 195.00(88.50,429.50) pg/mL,P=0.018],纽约心功能分级显著减小(P=0.025)。多因素logistic回归分析显示,沙库巴曲缬沙坦为左心房基质不良的持续性房颤患者导管消融术后6个月无房颤复发的保护性因素(OR=0.291,95%CI:0.094~0.904,P=0.033)。结论:沙库巴曲缬沙坦可有效减少持续性房颤导管消融术后6个月的复发率,改善其左心功能,获益可能主要来自对左心房不良基质的改善作用。Objective:To investigate the effect of sacubitril/valsartan on the mid-and long-term prognosis in patients with persistent atrial fibrillation undergoing catheter ablation.Methods:A retrospective analysis encompassed 210 patients who underwent catheter ablation for persistent atrial fibrillation at our medical facility between January 2019 and November 2022.Participants were categorized into two groups:the sacubitril/valsartan group(ARNI group,n=93) and the ACEI/ARB group(n=117).A 1∶1 propensity score matching method was employed to compare discrepancies in procedure-associated parameters(procedure duration,operative approach,single-loop isolation rate,left atrial substrate,pre-and post-surgery left atrial pulse pressure,mean left atrial pressure),complications,composite endpoint events,and indicators of left heart function between the two cohorts.Results:After the application of propensity score matching,72 matched pairs were successfully included in the study.No statistically significant differences were observed in terms of procedure duration,single-loop isolation rate,instances of electrical resuscitation,pre-and post-operative left atrial pulse pressures,mean left atrial pressure,and postoperative complications between the two groups.In comparison to the ACEI/ARB group,the ARNI group exhibited a significantly reduced recurrence rate of atrial fibrillation(25.00% vs 11.11%,P=0.048) and a decreased occurrence of heart failure exacerbation(11.11% vs 2.78%,P=0.044) after 6 months operation.No noteworthy disparities were detected in cardiovascular mortality and readmission rates between the two groups.Subgroup analysis indicated no substantial distinction in the proportion of low voltage areas in substrate mapping between the two groups(65.28% vs 72.22%).Furthermore,individuals with poor left atrial substrate within the ARNI group demonstrated a significantly lower 6-month atrial fibrillation recurrence rate in comparison to the ACEI/ARB group(33.33% vs 12.00%,P=0.017).Six months follow-up showed that left atri

关 键 词：心房颤动 导管消融 沙库巴曲缬沙坦 复合终点事件 左心房基质 

分 类 号：R541.7[医药卫生—心血管疾病]