| Objective:To investigate the predictive value of preoperative monocyte/HDL cholesterol and red blood cell distribution width in patients with persistent atrial fibrillation for late recurrence of postoperative atrial fibrillation.Method:162 patients with persistent atrial fibrillation from January 1,2017 to December31,2021 were selected from the database of the Department of Cardiology,The First Affiliated Hospital of Nanchang University,and the cases were divided into 62 cases in the recurrence group and 100 cases in the non-recurrence group according to whether atrial fibrillation recurred after 3 months.Preoperative clinical data of the admitted patients were collected,and one-way and multi-way logistic regression analyses were used to identify risk factors for recurrence of AF.Meanwhile,receiver operating characteristic curves were drawn and the area under the curve was calculated to assess the predictive ability of the risk factors.Finally,the prediction model was established by combining the risk factors.In addition,data of a total of143 patients with persistent atrial fibrillation treated by radiofrequency ablation at the Department of Cardiology of Jiangxi Provincial People’s Hospital during the same period were collected as a validation group(68 cases of recurrence and 75 cases of non-recurrence).The prediction model was evaluated,and finally Nomogram plots were drawn to interpret the model.Result:The mean age of patients in the modeling group was 63(56.75,70.00)years,including 101 males(62.35%),with a mean follow-up time of 33.72(13.89,44.83)months,during which a total of 62(62%)patients had a late recurrence.There was a statistical difference in MHR,RDW,albumin,e GFR,left atrial internal diameter,and duration of AF disease between the two groups(P<0.05).Multifactorial logistic regression analysis showed that MHR(OR 1.284,95% CI 1.048-1.574,P=0.016),RDW(OR 2.043,95% CI 1.315-3.173,P<0.01),left atrial internal diameter(OR1.091,95% CI 1.021-1.167,P=0.01),and duration of AF(OR 1.019,95%CI1.004-1.033,P=0.013)were independent risk factors for recurrence of AF.ROC curve analysis showed that the area under the curve of MHR and RDW were 0.654(95%CI 0.563-0.745,P<0.01),0.677(95%CI 0.592-0.762,P<0.01).Combining the 4risk factors to build a prediction model,we found that the area under the ROC curve for the modeling group was 0.78(95% CI 0.705-0.856,P< 0.01),with a sensitivity of71% and a specificity of 76%.Meanwhile,the ROC curve was plotted and the AUC was calculated for the validation group,which had an AUC of 0.747(95% CI0.668-0.827,P<0.01),a sensitivity of 64.7%,and a specificity of 70.7%.The Hosmer-Lemeshow test value for the modeling group was 0.111;the Hosmer-Lemeshow test value for the validation group was 0.925,and the test values for both groups were >0.05.Conclusion:1,MHR,RDW,LAD,and duration of atrial fibrillation are independent risk factors for late recurrence after radiofrequency ablation in patients with persistent atrial fibrillation.2,A risk prediction model for late recurrence after radiofrequency ablation in patients with persistent atrial fibrillation was established based on the four independent risk factors,and after validation and evaluation,the prediction model proved to have some clinical application value.Finally,the Nomogram plot was drawn to visualize the prediction model and facilitate clinicians to assess the risk of late recurrence after radiofrequency ablation in patients with persistent atrial fibrillation. |
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