Okada Masato, Tanaka Nobuaki, Tanaka Koji, Hirao Yuko, Yoshimoto Issei, Harada Shinichi, Onishi Toshinari, Koyama Yasushi, Okamura Atsunori, Iwakura Katsuomi, Fujii Kenshi, Sakata Yasushi, Inoue Koichi
Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Am J Cardiol. 2021 Apr 1;144:67-76. doi: 10.1016/j.amjcard.2020.12.057. Epub 2020 Dec 29.
Catheter ablation (CA) of atrial fibrillation (AF) improves cardiac function, resulting in a decrease in plasma brain natriuretic peptide (BNP) levels in patients with reduced left ventricular ejection fraction (LVEF). This study sought to examine the pre-procedural and post-procedural correlations between BNP levels and cardiac function and the associations between the BNP levels and recurrence after CA in patients with AF and reduced LVEF. Of 3142 consecutive patients who underwent first-time CA of AF at our institute, a total of 217 patients with LVEF <50% were enrolled. Significant decrease in BNP levels (from a median of 198 [interquartile range 113 to 355] to 47.7 [22.7 to 135] pg/ml, p <0.001) and improvement in LVEF (from 39±9% to 61±16%, p <0.001) were observed 3 months after CA. There was a linear correlation between log-transformed BNP levels and cardiac measures (LVEF: r = -0.64; LV end-diastolic volume: r = 0.25; LV end-systolic volume: r = 0.43; left atrial volume: r = 0.52; all p <0.001). During a median follow-up of 35 months, AF recurrence after a 3-month blanking period was observed in 80 patients (37%). Cox proportional hazard regression analysis after adjustment for cardiac measures significant in univariate analysis revealed that early recurrence within the blanking period (hazard ratio, 4.88; 95% confidence interval, 2.89 to 8.25) and elevated post-procedural BNP levels (2.02 per unit log increase; 1.14 to 3.56) were significant predictors of AF recurrence, but pre-procedural BNP was not. In conclusion, post-procedural BNP levels at the end of the blanking period predicted subsequent AF recurrence in patients with reduced LVEF, independent of early recurrence.
导管消融（CA）治疗心房颤动（AF）可改善心功能，使左心室射血分数（LVEF）降低的患者血浆脑钠肽（BNP）水平下降。本研究旨在探讨LVEF降低的AF患者在CA术前和术后BNP水平与心功能之间的相关性，以及BNP水平与CA术后复发之间的关联。在我院连续接受首次AF-CA的3142例患者中，共有217例LVEF<50%的患者被纳入研究。CA术后3个月，观察到BNP水平显著下降（从中位数198[四分位间距113至355]降至47.7[22.7至135]pg/ml，p<0.001），LVEF有所改善（从39±9%提高到61±16%，p<0.001）。对数转换后的BNP水平与心脏指标之间存在线性相关性（LVEF：r = -0.64；左心室舒张末期容积：r = 0.25；左心室收缩末期容积：r = 0.43；左心房容积：r = 0.52；均p<0.001）。在中位随访35个月期间，80例患者（37%）在3个月的空白期后出现AF复发。对单因素分析中有意义的心脏指标进行调整后的Cox比例风险回归分析显示，空白期内的早期复发（风险比，4.88；95%置信区间，2.89至8.25）和术后BNP水平升高（每单位对数增加2.02；1.14至3.56）是AF复发的显著预测因素，但术前BNP不是。总之，空白期末的术后BNP水平可预测LVEF降低患者随后的AF复发，与早期复发无关。
