Watanabe Eiichi, Arakawa Tomoharu, Uchiyama Tatsushi, Kodama Itsuo, Hishida Hitoshi
Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
Int J Cardiol. 2006 Apr 14;108(3):346-53. doi: 10.1016/j.ijcard.2005.05.021. Epub 2005 Jun 17.
Cardioversion for atrial fibrillation (AF) is the most effective treatment for the restoration of sinus rhythm (SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein (hs-CRP) was predictive of the outcome of cardioversion for AF.
One hundred and six patients with a history of symptomatic AF lasting > or =1 day (age 63+/-14 years, mean+/-S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients (79%). By using selected cutoff values, multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF (AF duration< or =36 days, odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97-0.99), smaller left atrial diameter (left atrial diameter< or =40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction (left ventricular ejection fraction> or =60%, OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level (hs-CRP< or =0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140+/-144 days, AF recurred in 64 patients (76%). By using a cutoff value of hs-CRP> or =0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence (OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4%, respectively (log-rank test, p<0.0001).
hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.
心房颤动（AF）的心脏复律是恢复窦性心律（SR）最有效的治疗方法。最近，高敏C反应蛋白（hs-CRP）水平升高已被证明与房颤负荷相关，提示炎症增加了房颤持续的倾向。我们研究了高敏C反应蛋白（hs-CRP）水平是否可预测房颤心脏复律的结果。
106例有症状性房颤病史且持续时间≥1天的患者（年龄63±14岁，均值±标准差）接受了心脏复律。在心脏复律前立即进行超声心动图检查和hs-CRP检测。84例患者（79%）恢复了窦性心律。通过使用选定的临界值，多因素判别分析显示成功复律与房颤持续时间较短（房颤持续时间≤36天，比值比（OR）0.98；95%置信区间（CI）0.97 - 0.99）、左心房直径较小（左心房直径≤40 mm，OR 0.82，95% CI 0.71 - 0.94）、左心室射血分数保存较好（左心室射血分数≥60%，OR 0.92，95% CI 0.86 - 0.99）以及hs-CRP水平较低（hs-CRP≤0.12 mg/dL，OR 0.33，95% CI 0.21 - 0.51）之间存在显著关联。在140±144天的随访期内，64例患者（76%）房颤复发。通过使用hs-CRP≥0.06 mg/dL的临界值，Cox比例风险回归模型发现，在调整并存的心血管风险后，只有hs-CRP水平是房颤复发的独立预测因素（OR 5.30，95% CI 2.46 - 11.5）。当根据hs-CRP水平0.06 mg/dL对患者进行分组时，临界值以下和以上窦性心律维持的百分比分别为53%和4%（对数秩检验，p<0.0001）。
心脏复律前测定的hs-CRP水平是房颤心脏复律成功以及复律后窦性心律维持的独立预测因素。
