左心房应变和左心耳功能对非瓣膜性心房颤动患者导管消融后节律转归的增量预测价值。

Incremental predictive value of left atrial strain and left atrial appendage function in rhythm outcome of non-valvular atrial fibrillation patients after catheter ablation.

机构信息

Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Shanghai, China

Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Open Heart. 2021 Jun;8(1). doi: 10.1136/openhrt-2021-001635.

DOI:10.1136/openhrt-2021-001635

PMID:34172560

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8237744/

Abstract

OBJECTIVE

The purpose of this study was to develop a non-invasive and convenient nomogram based on speckle tracking echocardiography, left atrial appendage function and clinical factors to predict the risk of atrial fibrillation (AF) recurrence after catheter ablation.

METHODS

A total of 124 prospectively consecutive patients with AF treated with catheter ablation in our hospital was retrospectively analysis. Baseline echocardiographic parameters were measured by using transthoracic and transesophageal echocardiography before ablation. Multivariate analysis was performed for selecting predictors for a nomogram and internal validation and calibration were evaluated by the bootstep method.

RESULTS

During the follow-up of 12±3 months, 41 patients (33.1%) occurred AF recurrence after catheter ablation, while 83 patients (66.9%) had maintained sinus rhythm. Four predictors (AF type, left atrial appendage emptying flow velocity, left Atrial maximal volumes index and global longitudinal strain) with the P<0.5 was selected into the nomogram according to multivariate findings. Internal validation by bootstrapping with 1000 resamples was determined C-index of the nomogram for prediction AF recurrence was 0.901, which showed optimal discrimination and calibration of the established nomogram.

CONCLUSIONS

Nomogram based on echocardiography and clinical characteristics had good predictive performance for the possibility of AF recurrence, which providing practical guidance for individualised management of patients with AF after catheter ablation.

摘要

目的

本研究旨在开发一种基于斑点追踪超声心动图、左心耳功能和临床因素的非侵入性和便捷的列线图，以预测导管消融后心房颤动（AF）复发的风险。

方法

回顾性分析了我院 124 例接受导管消融治疗的 AF 患者。消融前通过经胸和经食管超声心动图测量基线超声心动图参数。采用多元分析选择列线图的预测因子，并通过 bootstep 方法评估内部验证和校准。

结果

在 12±3 个月的随访中，41 例（33.1%）患者在导管消融后发生 AF 复发，83 例（66.9%）患者维持窦性心律。根据多因素分析，有 4 个预测因子（AF 类型、左心耳排空流速、左心房最大容积指数和整体纵向应变）具有统计学意义（P<0.05），被纳入到列线图中。通过 bootstrap 方法进行 1000 次重采样的内部验证确定，该列线图预测 AF 复发的 C 指数为 0.901，表明该列线图具有较好的区分度和校准度。