生物医学工程与临床2024，Vol.28Issue(5) ：683-688.DOI:10.13339/j.cnki.sglc.20240819.011

心外膜脂肪厚度联合左心耳功能参数在预测阵发性房颤射频消融术后复发的价值

Value of epicardial fat thickness combined with left atrial appendage function parameters in predicting recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

李东婉 王华
生物医学工程与临床2024，Vol.28Issue(5) ：683-688.DOI:10.13339/j.cnki.sglc.20240819.011
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心外膜脂肪厚度联合左心耳功能参数在预测阵发性房颤射频消融术后复发的价值

Value of epicardial fat thickness combined with left atrial appendage function parameters in predicting recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

李东婉 1王华2
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作者信息

  • 1. 新乡医学院影像医学与核医学系,河南新乡 453003;洛阳市中心医院超声科,河南洛阳 471000
  • 2. 洛阳市中心医院超声科,河南洛阳 471000
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摘要

目的 探讨基于心外膜脂肪厚度(EFT)联合左心耳(LAA)功能参数的诊断模型在预测阵发性房颤(AF)患者射频消融术后复发的价值.方法 收集行射频消融手术的阵发AF患者47例,其中男性22例,女性25例;年龄41～77岁,平均年龄62.72岁;身体质量指数(BMI)18.0～29.6 kg/m2,平均BMI 25.26 kg/m2;高血压24例,糖尿病5例,冠心病13例,卒中或短暂性脑缺血发作(TIA)6例;低密度脂蛋白1.30～3.86 mmol/L,平均低密度脂蛋白2.29 mmol/L;高密度脂蛋白0.67～1.59 mmol/L,平均高密度脂蛋白1.07 mmol/L;血尿酸123.0～514.0 μmol/L,平均血尿酸303.70 μmol/L.术前进行经胸超声心动图(ITE)和经食管超声心动图(TEE)检查.术后3个月开始随访,将患者分为复发组与未复发组.通过单因素及主成分分析的方法探索阵发性AF术后复发的预测因子并建立预测术后复发的联合诊断模型.结果 单因素分析中,两组年龄、BMI、左心房(LA)前后径、EFT、LAA最大开口内径相比,复发组高于非复发组,差异有统计学意义[71(61.01,73.75)岁vs 65(54.25,69.02)岁、(26.81±2.19)kg/m2vs(24.84±2.83)kg/m2、(43.42±4.58)mm vs(40.34±4.16)mm、5.63(5.30,5.99)mm vs 4.15(3.67,5.03)mm、(21.24±3.67)mm vs(18.37±2.81)mm.P＜0.05];复发组 LAA 排空速度、LAA 充盈速度、LAA峰值应变低于非复发组,差异有统计学意义[33.55(27.93,40.28)cm/s vs 43.40(33.70,77.63)cm/s、(35.06±11.02)cm/s vs(45.26±14.86)cm/s、5.85(5.18,7.08)vs 9.90(8.70,13.10).P＜0.05].采用主成分分析法构建的联合诊断模型综合评分截断值为16.695时,诊断阵发性AF射频消融术后复发的曲线下面积为0.895,对应的灵敏度、特异度、准确度分别为90.0％、78.4％、82.9％.结论 EFT联合LAA功能参数在预测阵发性AF射频消融术后复发中有一定的诊断价值.

Abstract

Objective To explore the diagnostic value of a diagnostic model based on epicardial fat thickness(EFT)combined with left atrial appendage(LAA)functional parameters in predicting recurrence of patients with paroxysmal atrial fibrillation(AF)after radiofrequency ablation.Methods A total of 47 patients with paroxysmal AF who underwent radiofrequency ablation were enrolled,which included 22 males and 25 females,aged 41-77 years old with mean age of 62.72 years old;body mass index(BMI)was 18.0-29.6 kg/m2 with mean BMI of 25.26 kg/m2.There were 24 cases of hypertension,5 of diabetes,13 of coronary heart disease and 6 of stroke or transient ischemic attack(TIA).The low density lipoprotein(LDL)was 1.30-3.86 mmol/L with mean LDL of 2.29 mmol/L;high density lipoprotein(HDL)was 0.67-1.59 mmol/L with mean HDL of 1.07 mmol/L;serum uric acid was 123.0-514.0 µmol/L with mean of 303.70 μmol/L.The transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)were performed before operation.Follow-up began 3-month after ablation,all patients were divided into recurrence group and non-recurrence group.The predictive factors of postoperative recurrence of paroxysmal AF were ex-plored by univariate analysis and principal component analysis,and combined diagnostic model for predicting postoperative recur-rence was established.Results In univariate analysis,the age,BMI,left atrial(LA)anteroposterior diameter,EFT and maximum LAA aperture diameter of recurrent group were statistically significantly higher than those of non-recurrent group,and the differ-ences were statistically significant[7 1(61.01,73.75)years old vs 65(54.25,69.02)years old,(26.81±2.19)kg/m2 vs(24.84±2.83)kg/m2,(43.42±4.58)mm vs(40.34±4.16)mm,5.63(5.30,5.99)mm vs 4.15(3.67,5.03)mm,(21.24±3.67)mm vs(18.37±2.81)mm.P＜0.05].The LAA emptying velocity,LAA filling velocity and LAA peak strain of recurrent group were remarkably lower than those of non-recurrent group,and the difference was statistically significant[33.55(27.93,40.28)cm/s vs 43.40(33.70,77.63)cm/s,(35.06±11.02)cm/s vs(45.26±14.86)cm/s,5.85(5.18,7.08)vs 9.90(8.70,13.10).P＜0.05].The cut-off value of combined diagnostic model constructed by principal component analysis was 16.695,the area under curve for diagnosis recurrence after ra-diofrequency ablation of paroxysmal AF was 0.895,the corresponding sensitivity,specificity and accuracy were 90.0％,78.4％and 82.9％,respectively.Conclusion It is demonstrated that the EFT combined with LAA functional parameters showed certain diagnostic value in predicting the recurrence of paroxysmal AF after radiofrequency ablation.

关键词

心外膜脂肪厚度/经食管超声/左心耳/阵发性房颤

Key words

epicardial fat thickness/transesophageal ultrasound/left auricle/paroxysmal atrial fibrillation

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基金项目

洛阳市科学技术局应用技术研究与开发项目(2101032A)

出版年

2024
生物医学工程与临床
天津市生物医学工程学会,天津市第三中心医院

生物医学工程与临床

CSTPCD
影响因子：0.462
ISSN：1009-7090
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