Kawasaki Masanori, Tanaka Ryuhei, Miyake Taiji, Matsuoka Reiko, Kaneda Mayumi, Minatoguchi Shingo, Hirose Takeshi, Ono Koji, Nagaya Maki, Sato Hidemaro, Kawase Yoshiaki, Tomita Shinji, Tsuchiya Kunihiko, Matsuo Hitoshi, Noda Toshiyuki, Minatoguchi Shinya
Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
Cardiovasc Ultrasound. 2016 Jan 27;14:6. doi: 10.1186/s12947-016-0049-4.
Atrial fibrillation (AF) is associated with left atrial (LA) remodeling caused by pressure and/or volume (LAV) overload. Increased pulmonary capillary wedge pressure (PCWP) represents LA pressure overload. We recently reported that pulmonary capillary wedge pressure (ePCWP) can be estimated by the kinetics-tracking (KT) index that combines LA function and volume using speckle tracking echocardiography (STE), and has a strong correlation with PCWP measured by right heart catheterization (r = 0.92). Therefore, we hypothesized that ePCWP is the best echocardiographic predictor of successful AF ablation.
We enrolled 137 patients with paroxysmal AF (age: 61 ± 10 years) who underwent pulmonary vein isolation. We measured LAV index, LA emptying function (EF) and LA stiffness during sinus rhythm before ablation using STE. PCWP was noninvasively estimated by STE as we previously reported. Parameters were compared between a group with AF recurrence (n = 30, age: 59 ± 11 years) and a group with successful ablation (sinus rhythm maintained for >1 year) (n = 107, age 61 ± 11 years).
The ePCWP was correlated with PCWP measured by right heart catheterization (r = 0.76, p < 0.01). Compared with the non-recurrence group (n = 107, age: 61 ± 11), the AF recurrence group had significantly increased ePCWP (10.6 ± 3.5 vs 14.6 ± 2.9 mmHg, p < 0.01), minimum LAV index (29 ± 12 ml/m(2) vs 37 ± 14 ml/m(2), p < 0.01) and LA stiffness (0.47 ± 0.33 vs 0.83 ± 0.59, p < 0.01), but lower total LA EF (44 ± 11% vs 39 ± 13%, p < 0.01) before ablation. In multivariate logistic regression analysis, ePCWP was the most significant independent predictor of successful ablation. Using 13 mmHg of PCWP as the optimal cutoff value, the sensitivity and specificity for successful ablation were 73 and 77% (area under the curve = 0.81), respectively.
The ePCWP that is measured by the combination of LA function and volume before ablation was a better predictor of the successful ablation compared with LA function and volume separately. The ePCWP estimated by STE is useful to predict the successful ablation in paroxysmal AF, and could be useful to improve candidate selection for AF ablation.
心房颤动（AF）与由压力和/或容量（左房容积，LAV）超负荷引起的左房（LA）重构相关。肺毛细血管楔压（PCWP）升高代表左房压力超负荷。我们最近报道，使用斑点追踪超声心动图（STE）结合左房功能和容积的动力学追踪（KT）指数可估算肺毛细血管楔压（ePCWP），且其与右心导管测量的PCWP具有强相关性（r = 0.92）。因此，我们推测ePCWP是房颤消融成功的最佳超声心动图预测指标。
我们纳入了137例接受肺静脉隔离术的阵发性房颤患者（年龄：61±10岁）。在消融前的窦性心律期间，我们使用STE测量左房容积指数、左房排空功能（EF）和左房僵硬度。如我们之前报道，通过STE对PCWP进行无创性估算。对房颤复发组（n = 30，年龄：59±11岁）和消融成功组（窦性心律维持>1年）（n = 107，年龄61±11岁）的各项参数进行比较。
ePCWP与右心导管测量的PCWP相关（r = 0.76，p<0.01）。与非复发组（n = 107，年龄：61±11）相比，房颤复发组的ePCWP显著升高（10.6±3.5 vs 14.6±2.9 mmHg，p<0.01），最小左房容积指数（29±12 ml/m² vs 37±14 ml/m²，p<0.01）和左房僵硬度（0.47±0.33 vs 0.83±0.59，p<0.01）升高，但消融前的左房总EF较低（44±11% vs 39±13%，p<0.01）。在多因素逻辑回归分析中，ePCWP是消融成功的最显著独立预测指标。以13 mmHg的PCWP作为最佳截断值，消融成功的敏感性和特异性分别为73%和77%（曲线下面积 = 0.81）。
与单独的左房功能和容积相比，消融前通过结合左房功能和容积测量的ePCWP是消融成功的更好预测指标。通过STE估算的ePCWP有助于预测阵发性房颤消融的成功，且可能有助于改善房颤消融的候选者选择。
