Shaikh Amir Y, Esa Nada, Martin-Doyle William, Kinno Menhel, Nieto Iryna, Floyd Kevin C, Browning Clifford, Ennis Cynthia, Donahue J Kevin, Rosenthal Lawrence S, McManus David D
From the *Department of Medicine, University of Massachusetts Medical School, Worcester, MA; †Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; ‡Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; §Division of Cardiology and Electrophysiology, University of Massachusetts Medical School, Worcester, MA; and ¶Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
Crit Pathw Cardiol. 2015 Dec;14(4):157-65. doi: 10.1097/HPC.0000000000000060.
Predicting which patients will be free from atrial fibrillation (AF) after pulmonary vein isolation (PVI) remains challenging. Clinical risk prediction scores show modest ability to identify patients at risk for AF recurrence after PVI. B-type natriuretic peptide (BNP) is associated with risk for incident and recurrent AF but is not currently included in existing AF risk scores. We sought to evaluate the incremental benefit of adding preoperative BNP to existing risk scores for predicting AF recurrence during the 6 months after PVI.
One hundred sixty-one patients with paroxysmal or persistent AF underwent an index PVI procedure between 2010 and 2013; 77 patients (48%) had late AF recurrence after PVI (>3 months post-PVI) over the 6-month follow-up period.
A BNP greater than or equal to 100 pg/dL (P=0.01) and AF recurrence within 3 months after PVI (P<0.001) were associated with late AF recurrence in multivariate analyses. Addition of BNP to existing clinical risk scores significantly improved the areas under the curve for each score, with an integrated discrimination improvement of 0.08 (P=0.001) and a net reclassification improvement of 60% (P=0.001) for all risk scores.
Circulating BNP levels are independently associated with late AF recurrence after PVI. Inclusion of BNP significantly improves the discriminative ability of CHADS2, CHA2DS2-VASc, R2CHADS2, and the HATCH score in predicting clinically significant, late AF recurrence after PVI and should be incorporated in decision-making algorithms for management of AF. B-R2CHADS2 is the best score model for prediction of late AF recurrence.
预测哪些患者在肺静脉隔离（PVI）后将不再发生心房颤动（AF）仍然具有挑战性。临床风险预测评分在识别PVI后有AF复发风险的患者方面能力有限。B型利钠肽（BNP）与新发和复发AF的风险相关，但目前未纳入现有的AF风险评分中。我们试图评估将术前BNP添加到现有风险评分中对预测PVI后6个月内AF复发的增量益处。
2010年至2013年间，161例阵发性或持续性AF患者接受了首次PVI手术；在6个月的随访期内，77例患者（48%）在PVI后出现晚期AF复发（PVI后>3个月）。
在多变量分析中，BNP大于或等于100 pg/dL（P=0.01）和PVI后3个月内AF复发（P<0.001）与晚期AF复发相关。将BNP添加到现有的临床风险评分中显著改善了每个评分的曲线下面积，所有风险评分的综合鉴别改善为0.08（P=0.001），净重新分类改善为60%（P=0.001）。
循环BNP水平与PVI后晚期AF复发独立相关。纳入BNP显著提高了CHADS2、CHA2DS2-VASc、R2CHADS2和HATCH评分在预测PVI后临床上显著的晚期AF复发方面的鉴别能力，应纳入AF管理的决策算法中。B-R2CHADS2是预测晚期AF复发的最佳评分模型。
