生长分化因子 15 在导管消融后心房颤动复发中的预测价值。
The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation.
机构信息
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, China.
出版信息
Mediators Inflamm. 2020 Aug 21;2020:8360936. doi: 10.1155/2020/8360936. eCollection 2020.
The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(8541701)ng/L vs. 1062(6511374)ng/L, = 0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(8891768) ng/L vs. 1062(6941373)ng/L, = 0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (5791270) ng/L vs. 1155 (7351632)ng/L, < 0.001]. The baseline GDF-15 correlated significantly with LAP ( = 0.296, < 0.001) and LAAV( = -0.235, = 0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank = 0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, = 0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, = 0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.
射频导管消融（RFCA）后心房颤动（AF）复发的机制尚不清楚。本研究旨在探讨生长分化因子-15（GDF-15）与消融术后 AF 患者复发事件之间的关系。我们前瞻性纳入了 150 例连续接受 RFCA 的 AF 患者。收集患者的临床信息。入院第二天早上和 RFCA 后 3 个月采集血样，采用酶联免疫吸附试验（ELISA）测定 GDF-15 浓度。所有患者在 RFCA 后特定时间（第 1/3/6/12/18/24 个月）进行随访，记录复发事件。在中位随访 14.0 个月期间，37 例（24.7%）患者出现 AF 复发。持续性 AF 组的基线血清 GDF-15 水平明显高于阵发性 AF 组[1140（8541701）ng/L 比 1062（6511374）ng/L， = 0.039]。复发组的基线血清 GDF-15 水平明显高于未复发组[1287（8891768）ng/L 比 1062（6941373）ng/L， = 0.022]。RFCA 后 3 个月血清 GDF-15 水平明显低于基线[870（5791270）ng/L 比 1155（7351632）ng/L， < 0.001]。基线 GDF-15 与 LAP（ = 0.296， < 0.001）和 LAAV（ = -0.235， = 0.003）呈显著正相关。Kaplan-Meier 分析显示，基线 GDF-15 较高（≥1287.3ng/L）组的无事件生存时间明显低于基线 GDF-15 较低（<1287.3ng/L）组[17.1 个月比 20.4 个月，Log Rank = 0.017]。多因素 Cox 回归分析显示，基线 GDF-15（HR 1.053，95%CI 1.0071.100， = 0.022）和 LAD（HR 1.124，95%CI 1.0111.250， = 0.030）是 RFCA 后 AF 复发的独立预测因子。本研究表明，术前 GDF-15 升高与左心房重构有关，并可作为消融后 AF 复发的预测因子。
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