Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Interv Card Electrophysiol. 2024 Aug;67(5):1093-1108. doi: 10.1007/s10840-023-01661-2. Epub 2023 Oct 19.
The fibrosis-4 (FIB-4) index is a noninvasive scoring system that is used to assess the progression of liver fibrosis. This study aimed to assess whether the FIB-4 index is associated with recurrent atrial fibrillation (AF) after catheter ablation in patients with and without heart failure (HF).
We included 1,184 patients who underwent initial AF catheter ablation between 2016 and 2021. The patients were classified into low-risk (< 1.3), intermediate-risk (1.3-2.67), and high-risk (> 2.67) groups based on their FIB-4 indices at baseline. The patients were divided into HF (n = 552) and non-HF groups (n = 632); the HF group was further divided into paroxysmal AF (PAF) and non-PAF groups. AF recurrence after catheter ablation was then compared among the groups.
In the non-HF group, no significant differences in recurrence after ablation were observed between the low-(n = 219), intermediate-(n = 364), and high-risk (n = 49) groups. In contrast, in the HF group, the intermediate-(n = 341) and high-risk (n = 112) groups had significantly higher recurrence rates than the low-risk group (n = 99) (log-rank test, p = 0.005). This association remained significant after multivariate analysis (hazard ratio [HR]:1.374; p = 0.027). The FIB-4 index increased incrementally as the brain natriuretic peptide levels and severity of tricuspid regurgitation increased. The FIB-4 index was an independent predictor of recurrence in the non-PAF HF group (HR:1.498; p = 0.007) but not in the PAF group.
The FIB-4 index may be a useful predictor of AF recurrence after catheter ablation in patients with HF, particularly in those with non-PAF.
纤维化 4 指数（FIB-4）是一种用于评估肝纤维化进展的非侵入性评分系统。本研究旨在评估 FIB-4 指数是否与心力衰竭（HF）患者和无心力衰竭患者经导管消融治疗后复发性心房颤动（AF）相关。
我们纳入了 2016 年至 2021 年间接受初始 AF 导管消融的 1184 例患者。根据基线时的 FIB-4 指数，患者被分为低危（<1.3）、中危（1.3-2.67）和高危（>2.67）组。患者被分为 HF（n=552）和非 HF 组（n=632）；HF 组进一步分为阵发性 AF（PAF）和非 PAF 组。然后比较各组导管消融后 AF 复发情况。
在非 HF 组中，消融后复发率在低危（n=219）、中危（n=364）和高危（n=49）组之间无显著差异。相比之下，在 HF 组中，中危（n=341）和高危（n=112）组的复发率明显高于低危组（n=99）（对数秩检验，p=0.005）。多因素分析后这种相关性仍然显著（危险比[HR]：1.374；p=0.027）。FIB-4 指数随着脑钠肽水平和三尖瓣反流严重程度的增加而逐渐升高。FIB-4 指数是非 PAF 组 HF 患者复发的独立预测因子（HR：1.498；p=0.007），但在 PAF 组中不是。
FIB-4 指数可能是 HF 患者经导管消融后 AF 复发的有用预测指标，尤其是在非 PAF 患者中。
