Luo Yan, Luo Duan, Yang Guoshu, Huang Wenchao, Tang Yan, Xu Bao, He Guijun, Yang Yongxin, He Jialing, Sun Huaxin, Cai Lin, Zhang Zhen, Liu Hanxiong, Xiong Shiqiang
Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu, 610014, Sichuan, China.
School of Materials Science and Engineering, Key Laboratory of Advanced Technologies of Materials Ministry of Education, Southwest Jiaotong University, Chengdu, 610031, China.
Cardiovasc Diabetol. 2024 Aug 7;23(1):291. doi: 10.1186/s12933-024-02388-8.
Atrial fibrillation (AF) is acknowledged as a disease continuum. Despite catheter ablation being recommended as a primary therapy for AF, the high recurrence rates have tempered the initial enthusiasm. Insulin resistance (IR) has been established as an independent predictor for the onset of AF. However, the correlation between non-insulin-based IR indices and late AF recurrence in patients undergoing radiofrequency catheter ablation remains unknown.
A retrospective cohort of 910 AF patients who underwent radiofrequency catheter ablation was included in the analysis. The primary endpoint was late AF recurrence during the follow-up period after a defined blank period. The relationship between non-insulin-based IR indices and the primary endpoint was assessed using multivariate Cox hazards regression models and restricted cubic splines (RCS). Additionally, the net reclassification improvement and integrated discrimination improvement index were calculated to further evaluate the additional predictive value of the four IR indices beyond established risk factors for the primary outcome.
During a median follow-up period of 12.00 months, 189 patients (20.77%) experienced late AF recurrence, which was more prevalent among patients with higher levels of IR. The multivariate Cox hazards regression analysis revealed a significant association between these IR indices and late AF recurrence. Among the four indices, METS-IR provided the most significant incremental effect on the basic model for predicting late AF recurrence. Multivariable-adjusted RCS curves illustrated a nonlinear correlation between METS-IR and late AF recurrence. In subgroup analysis, METS-IR exhibited a significant correlation with late AF recurrence in patients with diabetes mellitus (HR: 1.697, 95% CI 1.397 - 2.063, P < 0.001).
All the four non-insulin-based IR indices were significantly associated with late AF recurrence in patients undergoing radiofrequency catheter ablation. Addressing IR could potentially serve as a viable strategy for reducing the late AF recurrence rate.
心房颤动（AF）被认为是一种疾病连续体。尽管导管消融被推荐作为AF的主要治疗方法，但高复发率减弱了最初的热情。胰岛素抵抗（IR）已被确立为AF发病的独立预测因素。然而，基于非胰岛素的IR指标与接受射频导管消融的患者晚期AF复发之间的相关性仍不清楚。
分析纳入了910例接受射频导管消融的AF患者的回顾性队列。主要终点是在规定的空白期后的随访期间晚期AF复发。使用多变量Cox风险回归模型和受限立方样条（RCS）评估基于非胰岛素的IR指标与主要终点之间的关系。此外，计算净重新分类改善和综合判别改善指数，以进一步评估这四个IR指标在主要结局既定危险因素之外的额外预测价值。
在中位随访期12.00个月期间，189例患者（占20.77%）发生晚期AF复发，在IR水平较高的患者中更为普遍。多变量Cox风险回归分析显示这些IR指标与晚期AF复发之间存在显著关联。在这四个指标中，代谢当量胰岛素抵抗（METS-IR）对预测晚期AF复发的基本模型提供了最显著的增量效应。多变量调整后的RCS曲线说明了METS-IR与晚期AF复发之间的非线性相关性。在亚组分析中，METS-IR在糖尿病患者中与晚期AF复发显著相关（风险比：1.697，95%置信区间1.397-2.063，P<0.001）。
所有四个基于非胰岛素的IR指标均与接受射频导管消融的患者晚期AF复发显著相关。解决IR问题可能是降低晚期AF复发率的可行策略。
