Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Medeniyet University, Goztepe Education and Research Hospital/Cardiology Clinic, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2024 Nov;40(11):2271-2281. doi: 10.1007/s10554-024-03218-4. Epub 2024 Aug 16.
Atrial fibrillation (AF) poses substantial challenges in cardiovascular diseases, impacting patient health and economic burdens. Understanding the mechanical effects of AF on the left atrium (LA) and assessing the influence of treatment modalities on LA functions are critical. This study aims to assess the efficacy of echocardiographic and biochemical parameters in predicting AF recurrence following second generation cryoballoon ablation (CB-2). Ninety-two patients with symptomatic AF, treated with CB-2 at Istanbul University-Cerrahpaşa, Faculty of Medicine, Department of Cardiology, were prospectively examined from January 2021 to July 2023. The study endeavors to develop a predictive model for AF recurrence, investigating the relationship between echocardiographic measurements and serum biomarkers with recurrence. The follow-up duration for echocardiographic assessments and biochemical analyses was systematically documented. The study revealed a significant enhancement in LA mechanical functions during echocardiographic follow-ups three months post-procedure. Specifically, LA strain parameters emerged as significant predictors of recurrence (LAsr: 95%CI 1.004-1.246, p = 0.047; LAsct: 95%CI 1.040-1.750, p = 0.024). Biochemical analyses demonstrated a correlation between elevated PRO-BNP levels and an increased risk of recurrence (95%CI 1.000-1.003, p = 0.012). Moreover, specific biomarkers such as MYBPHL, which demonstrated increased levels post-procedure, were deemed indicative of atrial damage, suggesting potential additional atrial substrate modification beyond PVI. Consequently, improvements in LA function post-cryoballoon ablation and biochemical markers have surfaced as potential indicators for predicting AF recurrence. This study elucidates the effectiveness of CB-2 in treating AF and its impact on LA functions. Notably, LA strain measurements and PRO-BNP levels have emerged as reliable indicators for predicting recurrence. Beyond clinical implications, our research establishes a foundation for a deeper understanding of the role of CB-2 in AF management and factors associated with recurrence.
心房颤动（AF）在心血管疾病中带来了重大挑战，影响患者的健康和经济负担。了解 AF 对左心房（LA）的机械影响，并评估治疗方式对 LA 功能的影响至关重要。本研究旨在评估超声心动图和生化参数在预测第二代冷冻球囊消融（CB-2）后 AF 复发中的疗效。2021 年 1 月至 2023 年 7 月，前瞻性检查了在伊斯坦布尔大学 - 切拉帕萨医学院心脏病学系接受 CB-2 治疗的 92 例有症状的 AF 患者。本研究旨在通过研究超声心动图测量值和血清生物标志物与复发的关系，为 AF 复发建立预测模型。系统记录了超声心动图评估和生化分析的随访时间。研究结果显示，在术后三个月的超声心动图随访中，LA 机械功能明显增强。具体而言，LA 应变参数是复发的显著预测指标（LAsr：95%CI 1.004-1.246，p=0.047；LAsct：95%CI 1.040-1.750，p=0.024）。生化分析表明，升高的 PRO-BNP 水平与复发风险增加相关（95%CI 1.000-1.003，p=0.012）。此外，术后水平升高的特定生物标志物如 MYBPHL 被认为是心房损伤的指标，表明在 PVI 之外可能有潜在的额外的心房基质修饰。因此，LA 功能在冷冻球囊消融后的改善和生化标志物的提高已经成为预测 AF 复发的潜在指标。本研究阐明了 CB-2 治疗 AF 的有效性及其对 LA 功能的影响。值得注意的是，LA 应变测量和 PRO-BNP 水平是预测复发的可靠指标。除了临床意义外，我们的研究还为深入了解 CB-2 在 AF 管理中的作用以及与复发相关的因素奠定了基础。
