Zhao Qing, Yang Wentao, Li Xiangdong, Yao Minghui, Guo Jianping, Wang Yutang, Shan Zhaoliang
Graduate School, Medical School of Chinese PLA, Beijing, China.
Department of Cardiovascular Medicine, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China.
Postepy Kardiol Interwencyjnej. 2023 Jun;19(2):163-170. doi: 10.5114/aic.2023.125317. Epub 2023 Feb 23.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been demonstrated as a valuable risk marker for mortality and morbidity of cardiovascular disease. Recurrence after atrial fibrillation (AF) radiofrequency catheter ablation remains common.
We investigated the predictive value of the pre-procedural level of NT-proBNP to differentiate high-risk patients for post-ablation AF recurrence.
326 individuals with nonvalvular AF and preserved systolic function after enduring an initial radiofrequency catheter ablation (RFCA) between March 2018 and December 2019 were categorized into a recurrent group and a non-AF recurrent group. The serum NT-proBNP levels were examined before the ablation procedure. The researchers used multivariate logistic regression to find the determinants of AF recurrence.
During a 14-month (interquartile range (IQR): 12-16) median follow-up, AF recurred in 84 (25.8%) patients. Patients in the recurrence group had considerably greater pre-ablation NT-proBNP levels (389.4 vs. 141.7 pg/ml, < 0.001 in non-paroxysmal AF and 348.0 vs. 99.4 pg/ml, < 0.001 in paroxysmal AF) as well as a greater left atrium (40 vs. 36 mm, = 0.01 in non-paroxysmal AF and 38 vs. 36 mm, = 0.01 in paroxysmal AF) than the non-AF recurrence group. A cut-off value of NT-proBNP ≥ 168.05 pg/ml identified AF recurrence with a sensitivity of 78.6% and specificity of 53.7% (area under ROC curve 0.68, 95% confidence interval (CI) 0.62-0.74, < 0.001). Kaplan-Meier examination revealed that the elevated NT-proBNP (≥ 168.05 pg/ml) group presented a considerably shorter period without an occurrence compared to the low-NT-proBNP group (18.4 vs. 22.2 months, log-rank = 0.001). Multivariate cox regression investigation showed that a level of NT-proBNP ≥ 168.05 pg/ml (hazard ratio (HR): 2.89, 95% CI: 1.71-4.903, < 0.001) was a reliable predictor of AF recurrence after RFCA.
A high pre-ablation NT-proBNP level was associated with AF recurrence, and it was also discovered to be a prognostic factor of recurrence of AF following RFCA.
N末端前B型利钠肽（NT-proBNP）已被证明是心血管疾病死亡率和发病率的重要风险标志物。心房颤动（AF）射频导管消融术后复发仍然很常见。
我们研究了术前NT-proBNP水平对区分消融后AF复发高危患者的预测价值。
2018年3月至2019年12月期间，326例非瓣膜性AF且首次射频导管消融（RFCA）后收缩功能保留的患者被分为复发组和非AF复发组。在消融术前检测血清NT-proBNP水平。研究人员使用多因素逻辑回归分析来确定AF复发的决定因素。
在14个月（四分位间距（IQR）：12-16）的中位随访期内，84例（25.8%）患者出现AF复发。复发组患者术前NT-proBNP水平显著更高（非阵发性AF中为389.4 vs. 141.7 pg/ml，<0.001；阵发性AF中为348.0 vs. 99.4 pg/ml，<0.001），左心房也更大（非阵发性AF中为40 vs. 36 mm，=0.01；阵发性AF中为38 vs. 36 mm，=0.01）。NT-proBNP≥168.05 pg/ml的截断值识别AF复发的灵敏度为78.6%，特异度为53.7%（ROC曲线下面积为0.68，95%置信区间（CI）为0.62-0.74，<0.001）。Kaplan-Meier检验显示，NT-proBNP升高（≥168.05 pg/ml）组无事件发生的时间明显短于低NT-proBNP组（18.4 vs. 22.2个月，对数秩检验=0.001）。多因素cox回归分析表明，NT-proBNP水平≥168.05 pg/ml（风险比（HR）：2.89，95%CI：1.71-4.903，<0.001）是RFCA后AF复发的可靠预测指标。
术前NT-proBNP水平高与AF复发相关，并且还发现它是RFCA后AF复发的一个预后因素。
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