应用改良 APPLE 评分预测低电压区。

Prediction of low-voltage areas using modified APPLE score.

机构信息

Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany.

Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany.

出版信息

Europace. 2021 Apr 6;23(4):575-580. doi: 10.1093/europace/euaa311.

DOI:10.1093/europace/euaa311

PMID:33279992

Abstract

AIMS

The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs.

METHODS AND RESULTS

In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233).

CONCLUSION

The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.

摘要

目的

在心房颤动（AF）患者中存在低电压区（LVAs）反映了左心房（LA）的电解剖基质，这对于个体化的 AF 管理至关重要。然而，包含在先前的 LVA 预测评分中的超声心动图前后 LA 直径并不能准确反映 LA 大小，并且受损的左心室射血分数（LV-EF）与心房心肌病并无直接关联。因此，我们旨在比较改良（m）APPLE 评分，该评分包括左心房容积（LAV）和左心房排空分数（LA-EF）与常规 APPLE 评分，以预测 LVAs。

方法和结果

在接受首次 AF 导管消融的患者中，通过高密度图在介入过程中确定 LVAs，并将其定义为信号幅度<0.5 mV。所有患者在介入前均接受心血管磁共振成像。APPLE 评分（年龄≥65 岁、持续性 AF、肾小球滤过率受损（eGFR）≤60 mL/min/1.73 m2、LA 直径≥43 mm 和 LVEF<50%）和（m）APPLE 评分（最后两个变量分别为 LAV≥39 mL/m2 和 LA-EF<31%）在基线时计算。研究人群包括 219 例患者[中位年龄 65 岁（四分位间距 57-72 岁），41%为女性，59%为持续性 AF，25%为 LVAs]。这两个评分均与 LVAs 显著相关[APPLE 评分的比值比（OR）为 1.817，95%置信区间（CI）为 1.376-2.399；（m）APPLE 评分的 OR 为 2.288，95%CI 为 1.650-3.172]。使用受试者工作特征曲线分析，（m）APPLE 评分[曲线下面积（AUC）为 0.779，95%CI 为 0.702-0.855]预测 LVAs 的效果优于 APPLE 评分（AUC 为 0.704，95%CI 为 0.623-0.784），但差异无统计学意义（P=0.233）。