基于影像学和血清学特征构建持续性心房颤动患者射频消融术后复发的列线图模型  

Construction of a nomogram model for recurrence of persistent AF after radiofrequency ablation based on imaging and serological features

作　　者：潘强强 卢家忠[1] 吕新才[1] 冉辉 张标[1] 戎成振[1] 张金刚 王洪巨 Pan Qiangqiang;Lu Jiazhong;LüXincai;Ran Hui;Zhang Biao;Rong Chengzhen;Zhang Jingang;Wang Hongju(Department of Cardiovascular Medicine,Fuyang Second People's Hospital,Fuyang 236015,Anhui Province,Chin)

机构地区：[1]阜阳市第二人民医院心血管内科,236015 [2]阜阳市第二人民医院检验科,236015 [3]阜阳市第二人民医院心血管介入科,236015 [4]蚌埠医科大学第一附属医院心血管内科

出　　处：《中华老年心脑血管病杂志》2024年第8期876-881,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的基于心脏影像学特点和血清标志物分析持续性心房颤动(atrial fibrillation,AF)患者环肺静脉隔离+顶部线+后壁线的射频消融术后复发的危险因素,并建立列线图模型。方法选取2022年6月至2023年9月阜阳市第二人民医院收治的持续性AF患者172例,根据术后6个月是否复发分为复发组51例和未复发组121例。于术前常规予以心电图、经胸和食管心动图检查,同时检测血常规和相关生化指标,均行环肺静脉隔离+顶部线+后壁线的射频消融术治疗,术后随访6个月。用二元logistic分析患者术后复发的独立危险因素,建立并评估列线图模型的诊断效能。结果复发组左心房直径、左心房容积指数、中性粒细胞、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、B型钠尿肽、C反应蛋白高于未复发组,左心耳峰值填充流速、左心耳峰值排空流速、左心耳射血分数低于未复发组(P<0.01)。二元logistic回归分析显示,持续性AF患者左心房容积指数升高(OR=1.160,95%CI:1.006~1.337)、左心耳峰值排空流速降低(OR=0.740,95%CI:0.583~0.940)、左心耳射血分数降低(OR=0.608,95%CI:0.422~0.877)、B型钠尿肽升高(OR=1.017,95%CI:1.004~1.030)和NLR升高(OR=10.116,95%CI:1.316~77.755)是环肺静脉隔离+顶部线+后壁线的射频消融术后复发的独立危险因素(P<0.05,P<0.01)。以左心房容积指数、左心耳峰值排空流速、左心耳射血分数、B型钠尿肽、NLR构建的列线图模型预测持续性AF患者术后复发的曲线下面积为0.889(95%CI:0.833~0.932)。结论持续性AF患者心脏影像学参数左心房容积指数、左心耳峰值排空流速、左心耳射血分数及血清标志物B型钠尿肽、NLR与环肺静脉隔离+顶部线+后壁线的射频消融术后复发密切相关,且相关列线图模型对术后复发的诊断价值较佳。Objective To investigate the risk factors for recurrence of persistent atrial fibrillation(AF)after radiofrequency ablation with circumferential pulmonary vein isolation+top line+back wall line based on the features of cardiac imaging and serum biomarkers,and then to establish a nomogram risk prediction model.Methods A total of 172 patients with persistent AF admitted to our hospital from June 2022 to September 2023 were enrolled and then according to recurrence or not in 6 months after surgery,they were divided into the recurrence group(51 cases)and the non-ecurrence group(121 cases).Before surgery,routine electrocardiography,and transthoracic and esophageal echocardiography were performed,while blood routine indicators and related biochemical indicators were measured.All patients underwent radiofrequency ablation with circumferential pulmonary vein isolation,top line,and back wall line.They were followed up for 6 months after surgery.Binary logistic analysis was used to analyze the independent risk factors for postoperative recurrence,and then a nomogram risk prediction model was constructed and its diagnostic performance was evaluated.Results Lager LAD,higher LAVI,neutrophil count and NLR,and elevated BNP and CRP levels,while lower LAAFV,LAAEV and LAAEF were observed in the recurrent group than those in the non-recurrent group(P<0.01).Binary logistic regression analysis showed that elevated LAVI(OR=1.160,95%CI:1.006-1.337),decreased LAAEV(OR=0.740,95%CI:0.583-0.940),decreased LAAEF(OR=0.608,95%CI:0.422-0.877),elevated BNP(OR=1.017,95%CI:1.004-1.030),and higher NLR(OR=10.116,95%CI:1.316-77.755)were independent risk factors for recurrence after radiofrequency ablation of pulmonary vein isolation+top line+posterior wall line in persistent AF patients(P<0.05,P<0.01).The AUC value of the nomogram model constructed with LAVI,LAAEV,LAAEF,BNP and NLR in predicting postoperative recurrence was 0.889(95%CI:0.833-0.932).Conclusion The cardiac imaging parameters LAVI,LAAEV and LAAEF,and serum biomarkers BNP and NLR are cl

关 键 词：心房颤动 射频消融术 复发 列线图 血清标志物 

分 类 号：R541.75[医药卫生—心血管疾病]