心房颤动射频消融术后左心房球形度预测复发的价值
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摘要
目的:研究心房颤动(房颤)射频消融术后患者左心房球形度对房颤复发的预测价值。方法:选取2016-05-2017-05郑州大学第一附属医院心内科实施射频消融手术治疗的房颤患者共117例。根据术后随访结果分为:(1)复发组50例。(2)未复发组67例。收集各组一般资料、心脏超声测量的左心房直径与左心室射血分数、左心房CTA测量的左心房容积、左右径、前后径、上下径,并计算左心房球形度。比较两组间左心房球形度及其他相关指标的差异有无统计学意义。以房颤是否复发作为因变量对左心房球形度及其他相关指标进行Logistic回归分析。对左心房球形度与其他指标进行相关性分析确定相关性。结果:(1)复发组左心房球形度高于未复发组[(86.2±6.1)%:(83.0±5.7)%,P<0.05],差异具有统计学意义。而其他指标在两组间的差异无统计学意义(均P>0.05)。(2)单因素及多因素Logistic回归分析显示左心房球形度与房颤射频消融术后复发有相关关系[OR=1.097,95%CI:(1.026,1.174),P=0.007],而其他指标与房颤射频消融术后复发的关系无统计学意义(均P>0.05)。(3)相关性分析显示左心房球形度与性别、年龄、糖尿病、高血压、冠心病、房颤类型、左心室射血分数、左心房上下径均无明显相关性,而与彩超测量的左心房直径(r=0.302,P=0.001)、CTA测量的左心房容积(r=0.287,P=0.002)、左心房左右径(r=-0.306,P=0.001)、左心房前后径(r=0.404,P=0.001)均具有明显相关性。结论:左心房球形度对房颤射频消融术后患者房颤的复发具有预测价值。
Objective:To study the predictive value of left atrial sphericity in patients with atrial fibrillation after radiofrequency ablation.Method:A total of 117 patients with atrial fibrillation underwent radiofrequency ablation in department of cardiology in the First Affiliated Hospital of Zhengzhou University from May 2016 to May2017.According to postoperative follow-up results,the patients were divided into:50 cases of recurrence group.There were 67 cases in the non-recurrent group.The left atrium diameter and left atrium ejection fraction,left atrium volume measured by CTA in left atrium,left and right diameter,anteroposterior diameter and upper and lower diameter measured by echocardiography were collected,and the degree of left atrial sphericity was calculated.The differences of left atrial sphericity and other related indexes between the two groups were compared.The Logistic regression analysis of left atrial sphericity and other related indicators was performed to assess whether atrial fibrillation recurred as a dependent variable.The correlation between left atrial sphericity and other indexes was analyzed.Result:(1)The left atrial sphericity of the recurrence group was higher than that of the non-recurrence group[(86.2± 6.1)% vs(83±5.7)%,P<0.05],and the difference was statistically significant.There was no significant difference in the other indexes between the two groups(P>0.05).(2)Single and multiple factor Logistic regression analysis showed that the atrial sphericity was associated with recurrence of atrial fibrillation after radiofrequency ablation[(OR=1.097,95%CI(1.026,1.174),P=0.007],and there was no statistically significant correlation between the recurrence of atrial fibrillation after radiofrequency ablation(P>0.05).(3)Correlation analysis showed that there was no significant correlation between atrial sphericity and sex,age,diabetes,hypertension,coronary heart disease,atrial fibrillation type,left ventricular ejection fraction,left atrium and upper and lower diameter.The left atrium diameter(r=0.302,P=0.001),left atrium volume(r=0.287,P=0.002),left atrium diameter(r=-0.306,P=0.001)and left atrium anterior and posterior diameter(r=0.404,P=0.001)were significantly correlated with the color Doppler ultrasound measurements.Conclusion:Left atrial sphericity is predictive of atrial fibrillation recurrence after radiofrequency ablation of atrial fibrillation.
Objective:To study the predictive value of left atrial sphericity in patients with atrial fibrillation after radiofrequency ablation.Method:A total of 117 patients with atrial fibrillation underwent radiofrequency ablation in department of cardiology in the First Affiliated Hospital of Zhengzhou University from May 2016 to May2017.According to postoperative follow-up results,the patients were divided into:50 cases of recurrence group.There were 67 cases in the non-recurrent group.The left atrium diameter and left atrium ejection fraction,left atrium volume measured by CTA in left atrium,left and right diameter,anteroposterior diameter and upper and lower diameter measured by echocardiography were collected,and the degree of left atrial sphericity was calculated.The differences of left atrial sphericity and other related indexes between the two groups were compared.The Logistic regression analysis of left atrial sphericity and other related indicators was performed to assess whether atrial fibrillation recurred as a dependent variable.The correlation between left atrial sphericity and other indexes was analyzed.Result:(1)The left atrial sphericity of the recurrence group was higher than that of the non-recurrence group[(86.2± 6.1)% vs(83±5.7)%,P<0.05],and the difference was statistically significant.There was no significant difference in the other indexes between the two groups(P>0.05).(2)Single and multiple factor Logistic regression analysis showed that the atrial sphericity was associated with recurrence of atrial fibrillation after radiofrequency ablation[(OR=1.097,95%CI(1.026,1.174),P=0.007],and there was no statistically significant correlation between the recurrence of atrial fibrillation after radiofrequency ablation(P>0.05).(3)Correlation analysis showed that there was no significant correlation between atrial sphericity and sex,age,diabetes,hypertension,coronary heart disease,atrial fibrillation type,left ventricular ejection fraction,left atrium and upper and lower diameter.The left atrium diameter(r=0.302,P=0.001),left atrium volume(r=0.287,P=0.002),left atrium diameter(r=-0.306,P=0.001)and left atrium anterior and posterior diameter(r=0.404,P=0.001)were significantly correlated with the color Doppler ultrasound measurements.Conclusion:Left atrial sphericity is predictive of atrial fibrillation recurrence after radiofrequency ablation of atrial fibrillation.
引文
[1] Verma A,Jiang C,Betts T,et al.Approaches to catheter ablation for persistent atrial fibrillation[J].N Engl J Med,2015,372(19):1812-1822.
[2] Ganesan A,Shipp N,Brooks A,et al.Long-term outcomes of catheter ablation of atrial fibrillation:a systematic review and meta-analysis[J].J Am Heart Assoc,2013,2(2):1-14.
[3]孔强,史力生,喻荣辉,等.射频消融不能终止的心房颤动患者的临床特点及相关危险因素分析[J].临床心血管病杂志,2017,33(3):242-245.
[4] Moon J,Lee H,Kim Y,et al.Prognostic implication of atrial pressures in patients with nonvalvular atrial fibrillation and preserved systolic function who undergo radiofrequency catheter ablation:apilot study[J].Int J Cardiol,2013,168(4):4388-4390.
[5] Bisbal F,Guiu E,Calvo N,et al.Left atrial sphericity:a new method to assess atrial remodeling.Impact on the outcome of atrial fibrillation ablation[J].J Cardiovasc Electrophysiol,2013,24(7):752-759.
[6] Hoffmeister P,Chaudhry M,Mendel J,et al.Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging:relevance to ablation[J].J Interv Card Electrophysiol,2007,18(3):217-223.
[7] Hunter R,Liu Y,Lu Y,et al.Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation[J].Circ Arrhythm Electrophysiol,2012,5(2):351-360.
[8] Nakamura K,Funabashi N,Uehara M,et al.Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form[J].Int J Cardiol,2011,148(2):139-147.
[9] Volume W.Shape,and Roundness of Quartz Particles[J].J Geology,1935,43(3):250-280.
[10]张志鹏,高连君,张树龙,等.中性粒细胞与淋巴细胞比值对孤立性心房颤动射频消融术后复发的预测价值[J].临床心血管病杂志,2017,33(3):246-250.
[11]Tsao H,Yu W,Cheng H,et al.Pulmonary vein dilation in patients with atrial fibrillation:detection by magnetic resonance imaging[J].J Cardiovasc Electrophysiol,2001,12(7):809-813.
[12]Osserman R.The isoperimetric inequality[J].Bull Am Math Soc,1978,84(10):1182-1238.
[13]Nedios S,Tang M,Roser M,et al.Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation:predictive value after ablative treatment[J].J Interv Card Electrophysiol,2011,32(2):87-94.
[14]Nedios S,Kosiuk J,Koutalas E,et al.Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation[J].J Interv Card Electrophysiol,2015,43(3):237-244.
[15]Osmanagic A,Moller S,Osmanagic A,et al.Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion:An Echocardiographic Study[J].Clin Cardiol,2016,39(7):406-412.
[16]卢振华,刘念,马长生,等.2型糖尿病合并持续性心房颤动导管消融术后复发因素研究[J].临床心血管病杂志,2017,33(4):201-206.
[2] Ganesan A,Shipp N,Brooks A,et al.Long-term outcomes of catheter ablation of atrial fibrillation:a systematic review and meta-analysis[J].J Am Heart Assoc,2013,2(2):1-14.
[3]孔强,史力生,喻荣辉,等.射频消融不能终止的心房颤动患者的临床特点及相关危险因素分析[J].临床心血管病杂志,2017,33(3):242-245.
[4] Moon J,Lee H,Kim Y,et al.Prognostic implication of atrial pressures in patients with nonvalvular atrial fibrillation and preserved systolic function who undergo radiofrequency catheter ablation:apilot study[J].Int J Cardiol,2013,168(4):4388-4390.
[5] Bisbal F,Guiu E,Calvo N,et al.Left atrial sphericity:a new method to assess atrial remodeling.Impact on the outcome of atrial fibrillation ablation[J].J Cardiovasc Electrophysiol,2013,24(7):752-759.
[6] Hoffmeister P,Chaudhry M,Mendel J,et al.Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging:relevance to ablation[J].J Interv Card Electrophysiol,2007,18(3):217-223.
[7] Hunter R,Liu Y,Lu Y,et al.Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation[J].Circ Arrhythm Electrophysiol,2012,5(2):351-360.
[8] Nakamura K,Funabashi N,Uehara M,et al.Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form[J].Int J Cardiol,2011,148(2):139-147.
[9] Volume W.Shape,and Roundness of Quartz Particles[J].J Geology,1935,43(3):250-280.
[10]张志鹏,高连君,张树龙,等.中性粒细胞与淋巴细胞比值对孤立性心房颤动射频消融术后复发的预测价值[J].临床心血管病杂志,2017,33(3):246-250.
[11]Tsao H,Yu W,Cheng H,et al.Pulmonary vein dilation in patients with atrial fibrillation:detection by magnetic resonance imaging[J].J Cardiovasc Electrophysiol,2001,12(7):809-813.
[12]Osserman R.The isoperimetric inequality[J].Bull Am Math Soc,1978,84(10):1182-1238.
[13]Nedios S,Tang M,Roser M,et al.Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation:predictive value after ablative treatment[J].J Interv Card Electrophysiol,2011,32(2):87-94.
[14]Nedios S,Kosiuk J,Koutalas E,et al.Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation[J].J Interv Card Electrophysiol,2015,43(3):237-244.
[15]Osmanagic A,Moller S,Osmanagic A,et al.Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion:An Echocardiographic Study[J].Clin Cardiol,2016,39(7):406-412.
[16]卢振华,刘念,马长生,等.2型糖尿病合并持续性心房颤动导管消融术后复发因素研究[J].临床心血管病杂志,2017,33(4):201-206.