阵发性心房颤动患者左心房及脑钠肽的功能研究与导管消融术后复发的预测
Functional studies of left atrium and BNP in patients with paroxysmal atrial fibrillation and the prediction of recurrence after CPVA.
作者信息
Xu M, Liu F, Ge Z-X, Li J-M, Xie X, Yang J-H
机构信息
Department of Echocardiography, The First Affiliated Hospital of Soochow University of Jiangsu Province, SuZhou, China.
出版信息
Eur Rev Med Pharmacol Sci. 2020 May;24(9):4997-5007. doi: 10.26355/eurrev_202005_21191.
OBJECTIVE
This study was aimed to observe the significance of the left atrium (LA) functional index combined with B-type natriuretic peptide (BNP) level in predicting recurrence in patients with paroxysmal atrial fibrillation (PAF) after circumferential pulmonary vein ablation (CPVA). Real-time three-dimensional echocardiography (RT-3DE) was used to observe the structural and functional changes of LA in patients with PAF after CPVA. BNP is a hemodynamic indicator of myocardial stretching increase in atrial fibrillation (AF) patients.
PATIENTS AND METHODS
243 patients with PAF who intended to undergo CPVA were selected in the study, and the following clinical data of the patients were collected. Firstly, the blood BNP levels measured before CPVA. Secondly, the measurements of routine echocardiography before CPVA. RT-3DE was used to obtain the time-volume curve of LA. Then, multivariate logistic regression analysis was used to analyze the factors affecting PAF recurrence after CPVA. Finally, we obtained the receiver operating characteristic (ROC) curve of PAF recurrence predicted by the independent risk factors.
RESULTS
A total of 233 AF patients with an average age of 63.1 ± 9.3 years (range, 39-75 years; male: female =195: 38) underwent CPVA. 42 patients had AF recurrence (18.0%) during 3-6months follow-up after an operation blanking period of 3 months, BNP in the Recurrence Group was higher than that in Sinus Rhythm Group (p≤0.001). The preoperative left minimum volume index (LAVImin), left atrial volume index before contraction (LAVIpre-a) were higher in Recurrence Group than in Sinus Rhythm Group (p≤0.001). Expansion index, Diastolic emptying index (DEI), Passive emptying index (PEI), Active emptying index (AEI) were lower in the Recurrence Group than in the Sinus Rhythm Group (p≤0.001). Logistic regression analyses showed that BNP and DEI were independent predictors for PAF recurrence (OR=1.004, 95% CI: 1.01-1.07, p=0.001; OR=0.655, 95% CI: 0.57-0.75, p=0.001). The AUC of BNP, DEI and combined index for recurrence of CPVA were higher than LAVImax (p range: 0.001-0.013).
CONCLUSIONS
In patients with PAF treated with CPVA, the impaired DEI of LA reservoir function and increased BNP may be useful predictors of PAF recurrence.
目的
本研究旨在观察左心房（LA）功能指标联合B型利钠肽（BNP）水平在预测阵发性心房颤动（PAF）患者经环肺静脉消融术（CPVA）后复发中的意义。采用实时三维超声心动图（RT-3DE）观察PAF患者CPVA术后LA的结构和功能变化。BNP是心房颤动（AF）患者心肌牵张增加的血流动力学指标。
患者与方法
本研究选取243例拟行CPVA的PAF患者，收集患者以下临床资料。首先，CPVA术前测定血BNP水平。其次，CPVA术前进行常规超声心动图检查。采用RT-3DE获取LA的时间-容积曲线。然后，采用多因素logistic回归分析CPVA术后影响PAF复发的因素。最后，获得由独立危险因素预测PAF复发的受试者工作特征（ROC）曲线。
结果
共有233例AF患者接受了CPVA，平均年龄63.1±9.3岁（范围39 - 75岁；男∶女 = 195∶38）。42例患者在3个月手术空白期后的3 - 6个月随访期间出现AF复发（18.0%），复发组的BNP高于窦性心律组（p≤0.001）。复发组术前左心房最小容积指数（LAVImin）、收缩前左心房容积指数（LAVIpre-a）高于窦性心律组（p≤0.001）。复发组的扩张指数、舒张期排空指数（DEI）、被动排空指数（PEI）、主动排空指数（AEI）低于窦性心律组（p≤0.001）。logistic回归分析显示，BNP和DEI是PAF复发的独立预测因素（OR = 1.004，95%CI：1.01 - 1.07，p = 0.001；OR = 0.655，95%CI：0.57 - 0.75，p = 0.001）。BNP、DEI及联合指标预测CPVA复发的AUC高于LAVImax（p范围：0.001 - 0.013）。
结论
在接受CPVA治疗的PAF患者中，LA储器功能的DEI受损和BNP升高可能是PAF复发的有用预测指标。
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