多指标联合评估模型对阵发性心房颤动导管射频消融术后复发的预测价值

目的:探讨阵发性心房颤动(PAF)导管射频消融术(RFCA)后复发的相关独立危险因素以及多指标联合评估模型在预测RFCA后PAF复发中的价值。方法:回顾性分析于2017年1月—2018年10月在苏州大学附属第一医院心内科行首次RFCA的PAF患者186例,收集患者的一般临床资料、血清学资料、超声心动图资料、消融方式及口服药物资料等,并构建3种指标左心房内径(LAD)、中性粒细胞与淋巴细胞比值(NLR)及术后早期复发(ERAF)]联合的新评估模型,术后随访12个月,记录复发情况。采用二元Logistic回归分析建立预测模型,用受试者工作特性(ROC)曲线和曲线下面积(AUC)评估预测效率,最后用MedCalc软件的Z检验比较不同指标的AUC。结果:38例(20.43%)复发(复发组),148例(79.57%)无复发(未复发组)。两组LAD、NLR、ERAF、红细胞分布宽度(RDW)、总胆固醇(TC)、甲状腺素(T4)以及白细胞(WBC)差异有统计学意义(P<0.05)。多因素分析显示:LAD(OR=1.227,95%CI:1.090~1.382,P=0.001)、NLR(OR=2.020,95%CI:1.295~3.151,P=0.002)、ERAF(OR=16.886,95%CI:5.698~50.037,P<0.001)是PAF术后复发的独立危险因素。LAD、NLR及ERAF预测PAF术后复发的AUC分别为0.773、0.758和0.767。LAD、NLR及ERAF预测PAF复发的敏感度和特异度分别为0.730和0.741、0.865和0.585、0.595和0.939。LAD+NLR+ERAF联合评估模型预测PAF术后复发的AUC为0.902,敏感度为0.865,特异度为0.837。结论:本研究显示,LAD、NLR和ERAF是RFCA后PAF复发的独立危险因素,LAD+NLR+ERAF联合评估模型对RFCA后PAF复发风险的评估效能高于任何单一指标,其对PAF术后复发的预测更可靠。

The predictive value of multi-index combined evaluation model for recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation

Objective:To investigate the independent risk factors related to recurrence of paroxysmal atrial fibrillation(PAF)after radiofrequency catheter ablation(RFCA)and the value of the multi-index combined evaluation model in predicting the recurrence of PAF after RFCA.Methods:A total of 186 inpatients with PAF who underwent an initial RFCA in the First Affiliated Hospital of Soochow University from June 2017 and July 2019 were retrospectively analyzed.The general clinical data,serological data,echocardiographic data,ablation methods,and oral medication data were collected.A new combined evaluation model consisted of three indicators,including left atrial diameter(LAD),neutrophil to lymphocyte ratio(NLR),and early recurrence of atrial fibrillation after RFCA(ERAF)was established.The patients were followed up for 12 months after the operation and the recurrence was recorded.Binary logistic regression analysis was used to establish the prediction model.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the prediction efficiency.Finally,the Z-test of the MedCalc software was used to compare the AUC of different indicators.Results:Thirty-eight(20.43%)PAF patients had a recurrence(the recurrence group),and 148(79.57%)patients had no recurrence(the nonrecurrence group).There were significant differences in LAD,NLR,ERAF,red blood cell distribution width,total cholesterol,thyroxine,and white blood cells between the two groups(P<0.05).Multivariate analysis showed that LAD(OR=1.227,95%CI:1.090-1.382,P=0.001),NLR(OR=2.020,95%CI:1.295-3.151,P=0.002)and ERAF(OR=16.886,95%CI:5.698-50.037,P<0.001)were independent risk factors for postoperative recurrence of PAF.The AUC of LAD,NLR,and ERAF in predicting PAF recurrence was 0.773,0.758,and 0.767,respectively.The sensitivity and specificity of best cutoff LAD,NLR,and ERAF in predicting PAF recurrence were 0.730 and 0.741,0.865 and 0.585,0.595 and 0.939,respectively.The AUC of the combinedevaluation model which consisted of three indicators including LAD,NLR and ERAF in predicting PAF recurrence was 0.902,and the sensitivity and specificity were 0.865 and 0.837,respectively.Conclusion:This study shows that LAD,NLR,and ERAF are independent risk factors for PAF recurrence after RFCA.The combined evaluation model,which consisted of three indicators,including LAD,NLR,and ERAF,is more effective in assessing the risk of PAF recurrence after RFCA than any single index,and it is more reliable to predict the recurrence of PAF after RFCA.