The predictive value of left atrial and pulmonary vein morphological characteristics for early recurrence of atrial fibrillation after radiofrequency ablation
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目的:基于左心房和肺静脉CT血管成像(CT angiography,CTA)评估左心房和肺静脉形态学特征与射频消融术后心房颤动(房颤)早期复发的临床相关性.方法:回顾性分析我院2018年8月一2022年10月首次行射频消融术的患者,测量相关影像形态学参数,并于初始治疗后定期规律随访.收集患者临床资料,依据术后3个月内随访结果,将患者分为复发组和未复发组,对比分析两组患者临床及影像资料.采用logistic回归分析房颤复发的危险因素.采用受试者工作特征(receiver operating characteristic,ROC)曲线验证危险因素的预测价值.结果:共纳入229例患者,其中复发组87例,未复发组142例.未复发组与复发组患者左心房横径[LAD:(3.72±0.55)cm vs(4.37±0.82)cm,P＜0.001]、左心房横径/同层面胸椎椎体横径(LAVD:2.36±0.43 vs 2.83±0.66,P＜0.001)、左上肺静脉上下径[LSPV1:(1.97±0.46)cm vs(2.20±0.66)cm,P=0.002]、左心房容积[LAV:(56.07±24.40)cm3 vs(67.48±21.58)cm3,P＜0.001]、左心房球度(LASP:0.63±0.05 vs 0.58± 0.08,P＜0.001),以及饮酒史比例(16.9％vs 33.3％,P=0.004)均差异有统计学意义.多因素logistic回归分析结果显示,LAD(OR=1.002,95％CI:1.000～1.097,P=0.001)、LAV(OR=3.056,95％CI:2.821～3.327,P=0.003)、LASP(OR=1.000,95％CI:1.000～1.001,P=0.010)以及饮酒史(OR=10.392,95％CI:3.068～132.555,P=0.024)为房颤术后早期复发的独立危险因素.ROC曲线分析结果显示,LAD、LAV、LASP、饮酒史联合预测房颤射频消融术后早期复发的曲线下面积为0.793(95％CI:0.735～0.851,P＜0.001),灵敏度为70.42％,特异度为73.56％.结论:左心房相关CTA指标LAD、LAV、LASP及饮酒史可有效预测房颤患者射频消融术后早期复发.
Objective To evaluate the clinical correlation between left atrial and pulmonary vein morphological characteristics evaluate by CT angiography(CTA)and early recurrence of atrial fibrillation after radiofrequency catheter ablation(RFCA).Methods:All patients who received the initial RFCA surgery in our hospital from Au-gust 2018 to October 2022 were retrospectively reviewed,and their image morphological parameters were meas-ured,regular follow-up visits were conducted after the initial treatment.Clinical data were collected.Based on the 3 months'follow-up results after RFCA,patients were divided into the recurrence group and non-recurrence group.Clinical and imaging data of the two groups were compared.Logistic regression analysis was used to iden-tify risk factors for recurrence of atrial fibrillation.The predictive value was validated by receiver operating charac-teristic(ROC)curves.Results:A total of 229 patients were included,with 87 in the recurrence group and 142 in the non-recurrence group.The left atrial diameter[LAD:(3.72±0.55)cm vs(4.37±0.82)cm,P＜0.001],left atrio-vertebral diameter ratio(LAVD:2.36±0.43 vs 2.83±0.66,P＜0.001),left superior pulmonary vein di-ameter[LSPV1:(1.97±0.46)cm vs(2.20±0.66)cm,P=0.002],left atrial volume[LAV:(56.07±24.40)cm3 vs(67.48±21.58)cm3,P＜0.001],left atrial sphericity(LASP:0.63±0.05 vs 0.58±0.08,P＜0.001),and the proportion of alcohol history(16.9％vs 33.3％,P=0.004)were significantly different between the re-currence group and the non-recurrence group.Multivariate logistic regression analysis showed that LAD(OR=1.002,95％CI:1.000-1.097,P=0.001),LAV(OR=3.056,95％CI:2.821-3.327,P=0.003),LASP(OR=1.000,95％CI:1.000-1.001,P=0.010),and alcohol history(OR=10.392,95％CI:3.068-132.555,P=0.024)were independent risk factors for early postoperative recurrence.The ROC analysis results showed that the area under the curve for predicting early recurrence of atrial fibrillation after RFCA using the multi-factor combination of LAD,LAV,LASP,and alcohol history was 0.793(95％CI:0.735-0.851,P＜0.001),with a sensitivity of 70.42％and a specificity of 73.56％.Conclusion:Left atrium-related CTA indicators LAD,LAV and LASP,as well as alcohol history,may predict the early recurrence of atrial fibrillation patients af-ter RFCA.
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