| Objective:To analyze whether the recurrence rate after catheter ablation in patients with atrial fibrillation with heart failure(AF-HF)and atrial fibrillation without heart failure(N-AF-HF)is the same,and predict the two Whether there are differences in the risk factors of postoperative recurrence,and using ultrasound and clinical indicators to predict the risk factors of recurrence in AF-HF patients after catheter radiofrequency ablation,a recurrence prediction model to identify patients with AF-HF patients who are prone to postoperative recurrence is constructed.Methods:Selected preoperative AF patients(n=262)who underwent catheter ablation in the Department of Cardiology of a hospital from November 2019 to June 2021,and were divided into AF-HF group(n=110)and N-AF-HF group(n=152).The general data of the patients at admission were recorded: gender,age,operation time,body mass index(BMI),smoking history,drinking history;clinical data: AF course,AF type,N-terminal pro-B-type natriuretic peptide(N-terminal pro-B-type natriuretic peptide,NT-pro BNP),high-sensitivity troponin(hs-c Tn),D-dimer(D-dimer,DD),international normalized ratio(International Normalized Ratio,INR),cystatin C,creatinine(Serum creatinine,SCr),triglyceride(Triglycerides,TG),total cholesterol(Total cholesterol,TC),high density lipoprotein(High density 1ipoprotein,HDL-C),Low density lipoprotein(Low den Sity 1ipoprotein L,DL-C),and whether there is hypertension,CHA2DS2-VASc risk score,coronary heart disease,diabetes,cerebral infarction,bleeding history,etc,Echocardiographic indicators: peak left atrial appendage blood flow Left atrial appendage blood flow velocity(LAAV),Left atrium anteroposterior diameter(LAD),Right ventricular anterior and Posterior meridians(RVAPM),Interventricular septum thickness(IVSTd),Left ventricular end-diastolic diameter(LVED),Left ventricular posterior wall thickness(LVPWT),Right atrial diameter R(AD),tricuspid regurgitation velocity(Tricuspid regurgitation velocity,TRV),estimated pulmonary artery systolic pressure(Estimated pulmonary artery systolic pressure,EPAP),and left ventricular mass index(left ventricular mass index,LVMI),and follow-up within one year after catheter ablation(normal ECG and24-hour Holter monitoring)to monitor AF is No recurrence.According to the baseline data and follow-up results,the χ2 test and independent sample t test were used to analyze the risk factors that may affect their recurrence,and the risk factors with P<0.05 were included in the binary logistic regression analysis.For patients in the AF-HF group,Receiver operating curve(ROC)was drawn for the independent risk factors after logistic screening,and the area under the curve(AUC)was used to calculate the diagnostic efficacy of the parameters,and R software was used to build a recurrence prediction model.Results:(1)262 AF patients were divided into AF-HF and N-AF-HF groups,N-AF-HF In the HF group(n=152),no recurrence(n=114),and patients with recurrence(n=38),AF-HF group(n=110),no recurrence(n=70),recurrence(n=40),there was a statistically significant difference in the incidence of recurrence between the two groups(P<0.05).(2)General data showed that age and BMI were risk factors for recurrence in N-AF-HF group(P<0.05);age and gender were risk factors for recurrence in AF-HF group(P<0.05).(3)Clinical data showed: AF type,vascular disease,bleeding history,coronary heart disease were risk factors for recurrence in N-AF-HF group(P<0.05);AF type,disease course,stroke,bleeding history,CHA2DS2-VASc score,NT-Pro BNP It was a risk factor for recurrence in patients with AF-HF(P<0.05).(4)Ultrasound parameters showed that LAD was a risk factor for recurrence in N-AF-HF group;LAAV,LAD,TRV,and EPAP were risk factors for recurrence in AF-HF group(P<0.05).(5)N-AF-HF group: age,AF type,LAD,and BMI were independent risk factors for postoperative recurrence;AF-HF group: NT-Pro BNP,LAD,stroke,and AF duration were independent risk factors for postoperative recurrence.(6)The screened independent risk factors of AF-HF patients were incorporated into the AF recurrence prediction model,and the R software was used to draw a nomogram.The images showed that with the increase of NT-pro BNP,the number of strokes,LAD increased and With the prolongation of the course of AF,the score of the nomogram gradually increased,and the degree of risk also increased.(7)The independent influencing factors of AF-HF and the ROC curve of the model were drawn.The results showed that the stroke AUC was 0.69(95%CI0.58~0.73),the sensitivity was 60.32%,the specificity was 72.17%,and the AUC of LAD was 0.73(95%CI 0.64~0.77),the sensitivity was 72.37%,the specificity was72.53%,the AUC of NT-pro BNP was 0.72(95%CI 0.66~0.79),the sensitivity was71.34%,the specificity was 71.88%,and the AUC of the disease course was 0.71(95%CI 0.64~0.78),the sensitivity was 70.33%,and the specificity was 70.57%.The results showed that among the four indicators,LAD had the largest AUC.The ROC curve of the recurrence prediction model in the AF-HF group was drawn and the AUC was calculated.The AUC was 0.83(95%CI 0.73~0.86),the sensitivity was 78.42%,and the specificity was 83.28%,indicating that the prediction performance of the combined prediction model was better than that of the single factor index.better predictive performance(8)The consistency index(C-inde)of the constructed model was 0.79(95%CI0.65~0.98),and the absolute standard error between the model calibration curve and the actual curve was 0.037,indicating that the model fit was good.Conclusions:(1)HF has an impact on the recurrence rate of AF patients,and the recurrence rate of AF-HF patients is higher than that of N-AF-HF patients.(2)Risk factors for recurrence after catheter ablation differ between AF-HF and N-AF-HF patients.(3)The postoperative recurrence risk prediction model constructed based on the four independent risk factors of NT-Pro BNP,LAD,age,and AF duration in AF-HF patients before surgery has a certain predictive value for AF recurrence after catheter ablation. |
PDF Full Text Request