Rossi Valentina A, Krizanovic-Grgic Iva, Steffel Jan, Hofer Daniel, Wolber Thomas, Brunckhorst Corinna B, Ruschitzka Frank, Duru Firat, Breitenstein Alexander, Saguner Ardan M
Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
Center for Integrative Human Physiology, University of Zurich, Switzerland.
Cardiol J. 2022;29(3):413-422. doi: 10.5603/CJ.a2022.0012. Epub 2022 Mar 14.
Left atrial (LA) fibrosis in patients with atrial fibrillation (AF) is associated with an increased risk of AF recurrence after catheter ablation. Therefore, we searched for clinical risk factors that confer an increased risk of LA fibrosis, which can influence the treatment strategy.
We included 94 patients undergoing 3-dimensional electroanatomical voltage mapping-guided catheter ablation of AF. LA low-voltage areas during sinus rhythm as a surrogate parameter of fibrosis were measured with the CARTO3 mapping system and adjusted for LA volumes obtained by computed tomography. Blood tests including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and echocardiographic parameters of left ventricular function were also analyzed.
Patients were 62.5 ± 11.4 years old, and 29% were female. LA fibrosis was present in 65%, with 50% having a fibrotic area > 5% (≥ Utah-Stage 1). Mean left ventricular ejection fraction (LVEF) was 53.9 ± 10.5%. Patients with LA fibrosis had higher NT-proBNP levels (869 ± 1056 vs. 552 ± 859 ng/L, p = 0.001) and larger LA volumes (body surface area-corrected 63.3 ± 19.3 vs. 80 ± 27.1 mL/m2, p = 0.003). In univariable analyses, LA fibrosis was significantly associated with female gender, older age, increased LA volumes, hypertension, statin therapy, higher NT-proBNP values, and echocardiographic E/e'. In bivariable analyses, higher NT-proBNP, echocardiographic parameters of diastolic dysfunction, female gender, older age, and higher DR-FLASH scores remained as independent predictors of LA fibrosis.
In this single-center longitudinal study, surrogate parameters of elevated left-sided cardiac filling pressures such as higher NT-proBNP levels and higher echocardiographic E/e' values as well as female gender independently predicted the prevalence of LA fibrosis in patients referred for catheter ablation of AF.
心房颤动（AF）患者的左心房（LA）纤维化与导管消融术后AF复发风险增加相关。因此，我们寻找了可增加LA纤维化风险的临床危险因素，其可影响治疗策略。
我们纳入了94例接受三维电解剖电压标测引导下AF导管消融的患者。使用CARTO3标测系统测量窦性心律时LA低电压区域作为纤维化的替代参数，并根据计算机断层扫描获得的LA容积进行校正。还分析了包括B型利钠肽前体N末端（NT-proBNP）在内的血液检查以及左心室功能的超声心动图参数。
患者年龄为62.5±11.4岁，29%为女性。65%存在LA纤维化，其中50%的纤维化面积>5%（≥犹他分期1期）。平均左心室射血分数（LVEF）为53.9±10.5%。LA纤维化患者的NT-proBNP水平更高（869±1056 vs.552±859 ng/L，p=0.001）且LA容积更大（体表面积校正后63.3±19.3 vs.80±27.1 mL/m2，p=0.003）。在单变量分析中，LA纤维化与女性性别、年龄较大、LA容积增加、高血压、他汀类药物治疗、较高的NT-proBNP值以及超声心动图E/e'显著相关。在双变量分析中，较高的NT-proBNP、舒张功能障碍的超声心动图参数、女性性别、年龄较大以及较高的DR-FLASH评分仍然是LA纤维化的独立预测因素。
在这项单中心纵向研究中，较高的NT-proBNP水平和较高的超声心动图E/e'值等左侧心脏充盈压升高的替代参数以及女性性别独立预测了接受AF导管消融患者的LA纤维化患病率。
