左心房超声参数在心房颤动射频消融术后复发预测中的价值

Value of left atrial echocardiographic parameters in predicting recurrence following atrial fibrillation ablation

摘要

目的 探讨左心房超声参数对心房颤动患者经导管射频消融治疗后复发的预测意义,筛选其术后复发的独立危险因子并对比各参数预测效能。方法 回顾性纳入2022年1月—2024年6月在江苏省淮安市第二人民医院接受经导管射频消融治疗的心房颤动患者112例,依据术后随访情况分为复发组（41例）与未复发组（71例）。收集2组临床特征及左心房相关超声参数[左心房内径（left atrial diameter,LAD）、左心房容积指数（left atrial volume index,LAVI）、左心房最大容积（left atrial maximum volume,LAVmax）、左心房排空分数（left atrial ejection fraction,LAEF）、左心耳排空速度（left atrial appendage emptying velocity,LAAEV）、左心耳充盈速度（left atrial appendage filling velocity,LAAFV）、左心耳收缩期峰值应变率（systolic peak strain rate,SSR）]。通过多因素逐步 Logistic回归筛选疾病复发的独立危险因素,绘制受试者工作特征（receiver operating characteristic curve,ROC）曲线,评估各类左心房超声指标对复发事件的预测效能。结果 单因素分析显示,复发组病程更长、持续性心房颤动占比更高、术后胺碘酮使用率更低;LAD、LAVI、LAVmax明显增大,LAEF、LAAEV、SSR显著降低（均P<0.05）。多因素回归显示,病程（OR=1.183,95%CI：1.037~1.349）、LAVmax（OR=1.139,95%CI：1.082~1.199）是术后复发的独立危险因素,心房颤动类型（阵发性心房颤动,OR=0.162,95%CI：0.036~0.734）、SSR（OR=0.051,95%CI：0.006~0.428）、LAEF（OR=0.860,95%CI：0.794~0.931）为独立保护因素。ROC曲线显示,SSR单独预测的曲线下面积（area under the curve,AUC）为0.743,敏感度92.7%、特异度50.7%;LAVmax单独预测的AUC为0.843,敏感度82.9%、特异度74.6%;LAEF单独预测的AUC为0.628,敏感度90.2%、特异度32.4%。3个指标联合预测时,AUC为0.930,敏感度92.7%、特异度85.9%。结论 病程延长、LAVmax 升高是心房颤动RFCA术后复发独立危险因素,SSR、LAEF升高及阵发性心房颤动为独立保护因素;多参数联合模型能为临床精准评估复发风险、制定个体化治疗方案提供可靠参考。

Abstract

Objective To investigate the value of left atrial echocardiographic parameters in predicting recurrence following radiofrequency catheter ablation （RFCA） for atrial fibrillation （AF）, to identify independent risk factors for post-ablation recurrence, and to compare the predictive performance of these parameters. Methods A total of 112 AF patients who underwent RFCA at the Second People's Hospital of Huai'an City, Jiangsu Province from January 2022 to June 2024 were retrospectively enrolled. They were divided into recurrence （n=41） and non-recurrence （n=71） groups based on postoperative follow-up. Clinical features and left atrial echocardiographic parameters [left atrial diameter （LAD）, left atrial volume index （LAVI）, left atrial maximum volume （LAVmax）, left atrial emptying fraction （LAEF）, left atrial appendage emptying velocity （LAAEV）, left atrial appendage filling velocity （LAAFV）, left atrial appendage systolic peak strain rate （SSR）] were collected. Multivariate logistic stepwise regression identified independent risk factors for recurrence. Receiver operating characteristic （ROC） curves were used to evaluate the predictive performance of various left atrial echocardiographic parameters for recurrent events. Results Univariate analysis showed that the recurrence group had longer disease duration, a higher proportion of persistent AF, and lower postoperative Amiodarone application rate; LAD, LAVI and LAVmax were significantly increased, while LAEF, LAAEV and SSR were markedly decreased （all P<0.05）. Multivariate regression confirmed that disease duration （OR=1.183, 95%CI： 1.037―1.349） and LAVmax （OR=1.139, 95%CI： 1.082―1.199） were independent risk factors for postoperative recurrence, whereas type of AF （paroxysmal AF, OR=0.162, 95%CI： 0.036―0.734）, SSR （OR=0.051, 95%CI： 0.006―0.428） and LAEF （OR=0.860, 95%CI： 0.794―0.931） were independent protective factors. ROC curve analysis revealed that the AUC of SSR alone was 0.743, with a sensitivity of 92.7% and a specificity of 50.7%; the AUC of LAVmax alone was 0.843, with a sensitivity of 82.9% and a specificity of 74.6%; LAEF alone yielded an AUC of 0.628, accompanied by 90.2% sensitivity and 32.4% specificity. The combined model of three parameters achieved an AUC of 0.930, with 92.7% sensitivity and 85.9% specificity. Conclusion Prolonged disease duration and elevated LAVmax are independent risk factors for recurrence after RFCA in AF patients, while elevated SSR LAEF and paroxysmal AF serve as independent protective factors. The multi-parameter integrated model can provide a reliable basis for clinically accurate assessment of recurrence risk and formulation of individualized treatment strategies.

关键词

心房颤动 / 射频消融术 / 复发 / 左心房超声参数

Key words

atrial fibrillation / radiofrequency catheter ablation / recurrence / left atrial echocardiographic parameters