左心房应变联合心电P波参数预测肺静脉隔离后阵发性心房颤动复发  

Left atrial strain combined with electrocardiogram P-wave parameters for predicting recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation

作　　者：黄璇 潘璐 纳丽莎 周丽 叶晶晶 王婷婷 HUANG Xuan;PAN Lu;NA Lisha;ZHOU Li;YE Jingjing;WANG Tingting(Department of Cardiac Function Examination of Heart Centre,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部,宁夏银川750004

出　　处：《中国介入影像与治疗学》2024年第7期385-389,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 观察左心房应变联合心电P波参数预测以射频导管行肺静脉隔离(PVI)治疗阵发性心房颤动(PAF)后病变复发的价值。方法 前瞻性纳入首次接受PVI的88例PAF患者,根据治疗后6个月内心电图(ECG)结果将其分为复发组(n=30)及未复发组(n=58)。比较2组患者基本资料,左心房储备期应变(LASr)、左心房管道期应变(LAScd)、左心房收缩期应变(LASct)等经胸超声心动图(TTE)参数,以及P波时限、PR间期、P/PR(P波时限与PR间期比值)等ECG参数;对差异有统计学意义的参数行多因素logistic回归分析,筛选PAF经PVI后复发的独立预测因素,以受试者工作特征曲线及曲线下面积(AUC)评价各因素单独及联合预测效能,并以DeLong检验进行比较。结果 组间患者基本资料差异均无统计学意义(P均>0.05)。相比未复发组,复发组LASr、LAScd程度减低而P/PR增大(P均<0.05)。LASr(OR=0.805)、LAScd(OR=0.850)及P/PR(OR=1.119)均为PVI后PAF复发的独立预测因素(P均<0.05),其单独预测PVI后PAF复发的AUC分别为0.755、0.643及0.771,均低于三者联合(AUC为0.869)(P均<0.05)。结论 TTE与ECG参数可用于预测PVI后PAF复发;LASr、LAScd及P/PR联合的预测效能优于各单一参数。Objective To observe the value of left atrial strain combined with electrocardiogram(ECG)P-wave parameters for predicting recurrence of paroxysmal atrial fibrillation(PAF)after pulmonary vein isolation(PVI)using radiofrequency catheter.Methods Totally 88 PAF patients who planned to receive the first PVI were prospectively enrolled and divided into recurrence group(n=30)and non-recurrence group(n=58)according to results of ECG within 6 months after PVI.The patients’basic data,the transthoracic echocardiography(TTE)parameters,including left atrial reservoir strain(LASr),left atrial conduct strain(LAScd)and left atrial contraction strain(LASct),as well as ECG parameters including P-wave duration,PR interval and P/PR(the ratio of P-wave duration to PR interval)were compared between groups.Multivariate logistic regression analysis was performed of parameters being statistically different between groups to screen independent predictors for recurrence of PAF after PVI.The receiver operating characteristic curve and the area under the curve(AUC)were used to evaluate the predicting efficacy of individual independent predictors alone and their combination,and DeLong test was used for comparison.Results No significant difference of patients’basic data was found between groups(all P>0.05).Compared with those in non-recurrence group,LASr and LAScd decreased while P/PR increased in recurrent group(all P<0.05).LASr(OR=0.805),LAScd(OR=0.850)and P/PR(OR=1.119)were all independent predictors for recurrence of PAF after PVI(all P<0.05),with AUC of 0.755,0.643 and 0.771,respectively,all lower than their combination(AUC=0.869)(all P<0.05).Conclusion TTE and ECG parameters could be used to predict recurrence of PAF after PVI.The predicting efficacy of the combination of LASr,LAScd and P/PR was better than that of each alone.

关 键 词：心房颤动 导管消融术 复发 超声心动描记术 心电描记术 前瞻性研究 

分 类 号：R541.75[医药卫生—心血管疾病] R445.1[医药卫生—内科学] R540.41[医药卫生—临床医学]