心房颤动导管射频消融术后复发风险的预测模型研究  

A predictive model for recurrence risk after radiofrequency catheter ablation for atrial fibrillation

作　　者：周忠云[1] 马雯璐[2] 崔文竹[1] 王菁华[1] 孙聪 王萍[1] Zhou Zhongyun;Ma Wenlu;Cui Wenzhu;Wang Jinghua;Sun Cong;Wang Ping(Department of Cardiovascular Medicine,Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China;不详)

机构地区：[1]山东中医药大学第二附属医院心血管内科,济南250001 [2]山东中医药大学第二附属医院查体中心,济南250001

出　　处：《中国循证心血管医学杂志》2024年第11期1309-1313,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：山东省医药卫生科技发展计划项目(20220301031)。

摘　　要：目的通过对心房颤动导管射频消融(RFCA)术后复发的相关危险因素进行分析,构建Nomogram模型,便于临床医生对复发风险高的患者进行个性化管理。方法本研究共纳入2018年1月至2022年5月期间于山东中医药大学第二附属医院心内科接受首次导管射频消融术的阵发性心房颤动患者275例,收集患者住院期间的相关资料,定期随访12个月,根据随访结果将患者分为复发组(n=68)和非复发组(n=207),采用SPSS Statistic 27.0对两组间的危险因素进行单因素和多因素分析。根据分析结果,利用R软件构建Nomogram模型,并通过受试者工作特征曲线(ROC)验证该模型与CHA2DS2-VaSc评分模型的性能,利用校准曲线和决策曲线分析法(DCA)对该模型进行评价。结果68例患者在随访过程中出现复发,经过单因素和多因素分析显示体重指数(BMI)、阻塞性睡眠呼吸暂停(OSA)、陈旧性心肌梗死(previous MI)、左房内径(LAD)、左室射血分数(LVEF)和单纯肺静脉隔离(CPVI alone)是心房颤动导管射频消融术后复发的独立危险因素。用上述危险因素构建Nomogram模型,ROC曲线下面积(AUC)为0.94(95%CI:0.91~0.97)优于CHA2DS2-VaSc评分模型的ROC曲线下面积(AUC)0.82(95%CI:0.77~0.88)。校准曲线表现出良好的一致性。DCA分析表明,Nomogram模型在评价心房颤动导管射频消融术后复发方面显示出很大的正向收益率。结论BMI、OSA、陈旧性心肌梗死、LAD、LVEF和单纯肺静脉隔离是心房颤动导管射频消融术后复发的独立危险因素。基于上述危险因素构建的Nomogram模型具有较高的预测效能和可行性,可作为指导心房颤动导管射频消融术后患者评估复发风险的工具。Objective To establish a nomogram model through analyzing relative risk factors for recurrence of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA),and to be convenient for clinicians to manage patients with high AF recurrence risk in a personalized way.Methods The patients with paroxysmal atrial fibrillation(PAF,n=275)received first RFCA were chosen from Department of Cardiovascular Medicine in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from Jan.2018 to May 2022.The clinical materials were collected from patients during hospitalization time,and all patients were followed up for 12 months.According to follow-up results,the patients were divided into recurrence group(n=68)and non-recurrence group(n=207).The risk factors were given single-factor and multi-factor analyses by using SPSS Statistic 27.0 software in 2 groups.According to above analysis results,a nomogram model was established by using R software.The performance of nomogram model and CHA2DS2-VaSc scoring model were verified by using ROC curve analysis.The nomogram model was reviewed by using calibration curve and decision curve analysis(DCA).Results There were 68 patients with AF recurrence.The results of single-factor and multi-factor analyses showed that body mass index(BMI),obstructive sleep apnea syndrome(OSAS),old myocardial infarction(OMI),left atrial diameter(LAD),left ventricular ejection fraction(LVEF)and alone circumferential pulmonary vein isolation(CPVI)were independent risk factors for AF recurrence after RFCA.The results of ROC curve analysis showed that AUC of nomogram model was 0.94(95%CI:0.91~0.97),and AUC of CHA2DS2-VaSc scoring model was 0.82(95%CI:0.77~0.88).The performance of calibration curve had a higher consistency.The results of DCA analysis showed that the nomogram model had a higher positive yield in reviewing AF recurrence after RFCA.Conclusion BMI,OSAS,OMI,LAD,LVEF and alone CPVI are independent risk factors for AF recurrence after RFCA.The nomogram model establishe

关 键 词：心房颤动 导管射频消融术 复发 预测模型 

分 类 号：R541.75[医药卫生—心血管疾病]