2024 年第 1 期 第 19 卷

超声及临床指标对心房颤动伴心力衰竭患者射频消融术后心房颤动复发的预测价值

Predictive value of ultrasound and clinical indicators in atrial fibrillation recurrence after radiofrequency ablation in patients of atrial fibrillation with heart failure

作者：陈婷婷1 张蓓2 孙兵1

英文作者：Chen Tingting1 Zhang Bei2 Sun Bing1

单位：1贵州中医药大学第一附属医院超声科，贵州550003；2贵州医科大学附属医院超声科，贵州550004

英文单位：1Department of Ultrasound the First Affiliated Hospital of Guizhou University of Chinese Medicine Guizhou 550003 China; 2Department of Ultrasound the Affiliated Hospital of Guizhou Medical University Guizhou 550004 China

关键词：心房颤动；心力衰竭：心房颤动复发；预测模型

英文关键词：Atrialfibrillation;Heartfailure;Atrialfibrillationrecurrence;Predictionmodel

• 摘要：

• 目的  应用超声及临床指标预测心房颤动伴心力衰竭患者射频消融术后心房颤动复发的危险因素，并构建预测模型。方法  回顾性选取2020年11月至2022年6月于贵州医科大学附属医院行射频消融治疗的心房颤动伴心力衰竭患者110例。记录患者入院时临床资料、超声心动图指标。出院第3、6、12个月对患者进行随访，根据心房颤动复发情况将患者分为复发组和未复发组。分析心房颤动复发的危险因素并构建预测模型。结果  随访期间共40例患者心房颤动复发（复发组），其余70例患者未复发（未复发组）。复发组男性比例低于未复发组，年龄、持续性心房颤动比例、心房颤动病程、卒中比例、出血史比例、CHA2DS2-VASc评分、N末端B型脑钠肽前体（NT-proBNP）水平均大于/高于/长于未复发组（均P＜0.05）。复发组左心耳峰值血流速度低于非复发组，左心房前后径（LAD）、三尖瓣反流速度、估测肺动脉收缩压均高于非复发组（均P＜0.05）。二元Logistic回归分析结果显示，心房颤动病程、卒中、NT-proBNP、LAD是心房颤动复发的独立危险因素(均P＜0.05)。将NT-proBNP、卒中、LAD、心房颤动病程纳入预测模型。受试者工作特征曲线分析结果显示，卒中、LAD、NT-proBNP、心房颤动病程预测心房颤动复发的曲线下面积为0.69（95%置信区间：0.58~0.73）、0.73（95%置信区间：0.64~0.77）、0.72（95%置信区间：0.66~0.79）、0.71（95%置信区间：0.64~0.78），预测模型的曲线下面积为0.83（95%置信区间：0.73~0.86）。预测模型的一致性指数为0.79（95%置信区间：0.65~0.98，P＜0.05），模型校准曲线与实际曲线的绝对标准误为0.037。结论  心房颤动病程、卒中、NT-proBNP、LAD是心房颤动伴心力衰竭患者导管射频消融术后心房颤动复发的独立危险因素，通过上述指标构建列线图预测模型，其预测心房颤动复发风险的效能更佳。

• Objective  To predict risk factors for atrial fibrillation (AF) recurrence in patients of AF with heart failure (AF-HF) after radiofrequency ablation by ultrasound and clinical indexes, and to establish a prediction model. Methods  Totally 110 AF-HF patients who underwent radiofrequency ablation in the Affiliated Hospital of Guizhou Medical University from November 2020 to June 2022 were retrospectively selected. Clinical data and echocardiogram indicators of patients at admission were retrospectively recorded. Patients were followed-up at 3, 6 and 12 months after discharge, and they were divided into recurrence group and non-recurrence group according to the recurrence of AF. Risk factors affecting AF recurrence were analyzed, and a prediction model was established. Results  During follow-up, 40 cases had AF recurrence (recurrence group), and other 70 cases had no (non-recurrence group). Compared to non-recurrence group, the male rate in the recurrence group was lower, and age, persistent AF rate, AF duration, stroke rate, bleeding history rate, CHA2DS2-VASc score, and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in recurrence group were greater/higher/longer (all P<0.05). Compared to non-recurrence group, left atrial appendage peak flow velocity in recurrence group was lower, and left atrial diameter (LAD), tricuspid regurgitation velocity and estimated pulmonary systolic blood pressure in recurrence group were higher (all P<0.05). Binary Logistic regression analysis showed that AF duration, stroke, NT-proBNP and LAD were independent risk factors for AF recurrence (all P<0.05), and all above of them were enrolled into prediction model. Receiver operating characteristic curve analysis showed that the area under the curve (AUC) of stroke, LAD, NT-proBNP and AF duration were 0.69［95% confidence interval(CI)： 0.58-0.73］, 0.73（95% CI： 0.64-0.77）, 0.72（95% CI： 0.66-0.79） and 0.71（95% CI： 0.64-0.78）, respectively, and the area under the curve of the prediction model was 0.83（95% CI： 0.73-0.86）. The consistency index of the prediction model was 0.79 (95% CI： 0.65-0.98, P<0.05), and the absolute standard error between the model calibration curve and the actual curve was 0.037. Conclusion  AF duration, stroke, NT-proBNP and LAD are independent risk factors for AF recurrence in patients with AF-HF after catheter radiofrequency ablation. The nomogram prediction model is constructed from the above indicators, which has better performance in predicting the risk of AF recurrence.