心电图MVP评分对阵发性心房颤动射频导管消融术术后复发的预测价值  

Value of MVP ECG risk score on predicting postoperative recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation

作　　者：路瑜 刘梓瑞 杨正凯 王皓铖 时星宇 邹操[1] LU Yu;LIU Zirui;YANG Zhengkai;WANG Haocheng;SHI Xingyu;ZOU Cao(Department of Cardiovascular Medicine,the First Affiliated Hospital of Soochow University,Suzhou Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院心血管内科,江苏苏州215006

出　　处：《实用心电学杂志》2024年第5期454-460,共7页Journal of Practical Electrocardiology

基　　金：苏州市临床重点病种诊疗技术专项(LCZX202103);江苏省卫健委医学科研项目(K2023080);苏州大学横向课题(H190426)。

摘　　要：目的探讨阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者射频导管消融术术前体表心电图MVP评分对术后复发的预测价值。方法选取接受射频导管消融术的PAF住院患者299例为研究对象,根据心房颤动(简称房颤)复发与否分为房颤复发组(n=40)和窦性心律(简称窦律)维持组(n=259)。比较两组间术前MVP评分。通过ROC曲线分析确定MVP评分预测房颤消融术术后复发的最佳截断值,应用MVP评分临界值进行房颤消融术术后复发的生存曲线分析。结果(1)PAF患者消融术术后随访时间22.0(11.0,35.0)月,总体未复发率86.6%;(2)与窦律维持组相比,房颤复发组患者病程长[12.0(3.0,48.0)月vs.36.0(11.5,72.0)月,P<0.05]、术前MVP评分增加[(2.20±0.94)分vs.(3.40±1.12)分,P<0.01)],其余术前指标间差异无统计学意义;(3)单因素Cox回归分析提示,术前MVP评分和病程是影响房颤消融术术后复发的危险因素;多因素Cox回归分析结果显示,高术前MVP评分(OR=2.261,95%CI 1.700~3.007,P<0.01)是PAF消融术术后复发的独立危险因素;(4)PAF患者术前MVP评分预测消融术术后复发的ROC曲线下面积(AUC)为0.76(95%CI 0.674~0.843,P<0.05),最佳截断值为3分,敏感性为63.0%、特异性为85.0%。结论术前心电图MVP评分对PAF患者射频导管消融术术后复发有一定的预测价值。Objective To investigate the value of body surface MVP ECG risk score before radiofrequency catheter ablation on predicting postoperative recurrence in patients with paroxysmal atrial fibrillation(PAF).Methods We selected 299 inpatients with PAF who had been treated by radiofreqency catheter ablation as study objects.According to the presence or absence of the recurrence of atrial fibrillation(AF),they were divided into AF recurrence group(n=40)and sinus rhythm maintenance group(n=259).The preoperative MVP risk scores were compared between the two groups.By using ROC curve analysis,we determined the optimal cut-off value of MVP risk score on predicting postoperative recurrence after AF ablation,while the critical value of MVP risk score was utilized in the survival curve analysis of postoperative recurrence after AF ablation.Results(ⅰ)The follow-up time of patients with PAF after ablation was 22.0(11.0,35.0)months,and the overall non-recurrence rate was 86.6%.(ⅱ)Compared with the sinus rhythm maintenance group,patients in the AF recurrence group had longer course of disease[12.0(3.0,48.0)months vs.36.0(11.5,72.0)months,P<0.05],and increased preoperative MVP risk score[(2.20±0.94)points vs.(3.40±1.12)points,P<0.01)].There were no statistically significant differences in the remaining preoperative indexes between the two groups.(ⅲ)Univariate Cox regression analysis suggested that preoperative MVP risk score and course of disease were risk factors for postoperative recurrence after ablation.Multivariate Cox regression analysis showed that high preoperative MVP risk score(OR=2.261,95%CI 1.700-3.007,P<0.01)was an independent risk factor for postoperative recurrence after PAF ablation.(ⅳ)The area under curve(AUC)of preoperative MVP risk score was 0.76(95%CI 0.674-0.843,P<0.05)for predicting postoperative recurrence after ablation in PAF patients;the optimal cut-off value was 3 points,the sensitivity was 63.0%,and the specificity was 85.0%.Conclusion Preoperative MVP ECG risk score is valuable for predicting p

关 键 词：阵发性心房颤动 射频导管消融 复发 MVP评分 

分 类 号：R541.75[医药卫生—心血管疾病] R540.4[医药卫生—内科学]