左心房容积指数在非瓣膜性心房颤动患者电复律成功中的意义及其与复发的关系：一项诊断准确性研究
The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy.
作者信息
Akdemir Bariş, Altekin Refik Emre, Küçük Murathan, Yanikoğlu Atakan, Karakaş Mustafa Serkan, Aktaş Anil, Demir İbrahim, Ermiş Cengiz
机构信息
Clinic of Cardiology, Burdur State Hospital, Burdur, Turkey.
出版信息
Anadolu Kardiyol Derg. 2013 Feb;13(1):18-25. doi: 10.5152/akd.2013.003. Epub 2012 Oct 12.
OBJECTIVE
The aim of this study was to assess the predictive value of the left atrial volume index (LAVI) in electrical cardioversion (ECV) and observe the recurrence rate of atrial fibrillation (AF) after a successful ECV in patients with non-valvular atrial fibrillation.
METHOD
This study was designed as a diagnostic accuracy and prospective cohort study. Eighty patients (mean age 62±12 years; 52.5% female) were enrolled in study. LAVI was measured using the area-length method and the indexed body surface area. Patients in whom the sinus rhythm (SR) was established following the ECV were assessed according to the clinical and electrocardiography (ECG) findings at the first month and grouped as those with continued SR or recurrent AF. The Student's t, Mann-Whitney U, Fisher's exact, Chi-square tests, ROC and logistic regression analyses were used for statistical analysis.
RESULTS
Subsequent to the ECV, SR was achieved in 62.5% (n=50) of the patients. In those where SR was established, the AP-Lad (4.32±0.62 vs. 4.77±0.4 cm/p=0.002) and LAVI (35.3±11.5 vs. 53.1±10.1 mL/m2/p<0.001) values were observed to be lower. ECV success was found to be associated only with the LAVI (OR:1.122, 95%CI: 1.058-1.191, p<0.001). The AUC was found as 0.892±0.041 for the LAVI (95% CI:0.075-0.285, p<0.001). During the controls at the end of the 1st month, SR was maintained in 72% (n=36) of the successful ECV group. Among the patients with maintained SR, the antero-posterior left atrial dimension (4.17±0.62 vs. 4.72±0.5 cm/p=0.004) and LAVI (30.8±6.2 vs. 46.8±13.9 mL/m2/p<0.001) values were also observed to be lower. Only the LAVI was found to be associated with the recurrence of the AF (OR:1.355, 95% CI: 1.154-1.591, p<0.001). The AUC was found as 0.950±0.029 for the LAVI (95% CI:0.063-0.313, p=0.003)
CONCLUSION
Lower LAVI values before the ECV are strong and independent predictors of the success of the ECV and the maintenance of SR after a successful ECV.
目的
本研究旨在评估左心房容积指数（LAVI）在电复律（ECV）中的预测价值，并观察非瓣膜性心房颤动患者成功电复律后房颤（AF）的复发率。
方法
本研究设计为诊断准确性和前瞻性队列研究。80例患者（平均年龄62±12岁；52.5%为女性）纳入研究。采用面积-长度法和体表面积指数测量LAVI。根据电复律后第1个月的临床和心电图（ECG）结果，对电复律后建立窦性心律（SR）的患者进行评估，并分为持续窦性心律或房颤复发组。采用Student's t检验、Mann-Whitney U检验、Fisher精确检验、卡方检验、ROC分析和逻辑回归分析进行统计分析。
结果
电复律后，62.5%（n = 50）的患者实现了SR。在建立SR的患者中，观察到前后径左心房尺寸（4.32±0.62 vs. 4.77±0.4 cm/p = 0.002）和LAVI（35.3±11.5 vs. 53.1±10.1 mL/m2/p < 0.001）值较低。发现电复律成功仅与LAVI相关（OR：1.122，95%CI：1.058 - 1.191，p < 0.001）。LAVI的AUC为0.892±0.041（95%CI：0.075 - 0.285，p < 0.001）。在第1个月末的随访中，成功电复律组的72%（n = 36）维持了SR。在维持SR的患者中，也观察到前后径左心房尺寸（4.17±0.62 vs. 4.72±0.5 cm/p = 0.004）和LAVI（30.8±6.2 vs. 46.8±13.9 mL/m2/p < 0.001）值较低。仅发现LAVI与房颤复发相关（OR：1.355，95%CI：1.154 - 1.591，p <
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