摘要
目的探讨12导联心电图联合经胸超声心动图综合评估在预测射频消融(RFCA)术后复发中的临床价值。方法回顾性分析2018年1月至2022年12月在湖北省中医院行RFCA治疗的84例阵发性房颤患者,根据术后随访1年内是否复发分为复发组(n=26)与未复发组(n=58)。记录术前12导联心电图特征[P波振幅、最大P波平均时限(Pmax)及P波离散度(Pd)、V1导联P波终末电势(Ptf)],比较组间患者经胸超声心动图指标[左心室射血分数(LVEF)、二尖瓣口舒张早期流速/舒张早期速度的均值(E/e’值)、左心房前后径、左心房最大容积、左心房最小容积、左心房射血分数(LAEF)、左心房总体纵向应变(GLAS)、经R-R间期标化的应变达峰时间标准差(SD-TPS)]差异,并进行多因素Logistic回归分析及列线图分析,建立术后复发预测模型并采用受试者操作特征(ROC)曲线验证其预测价值。结果复发组患者的P波振幅、Pmax、Pd分别为(92.15±5.16)μV、(122.13±6.46)ms、(51.12±4.16)ms,均高于未复发组[(85.44±5.02)μV、(97.48±5.13)ms、(36.99±3.17)ms],复发组Ptf为(0.02±0.01)ms·s,低于未复发组[(0.04±0.01)ms·s],差异均有统计学意义(P<0.05)。复发组和未复发组患者的LVEF、E/e’、左心房最大容积、左心房最小容积、LAEF比较,差异均无统计学意义(P>0.05);复发组患者的左心房前后径、SD-TPS分别为(45.44±3.15)mm、(8.26±2.16)ms,均高于未复发组[(40.16±4.55)mm、(6.22±2.41)ms],复发组GLAS为(13.69±6.16)%,低于未复发组[(21.98±6.13)%],差异均有统计学意义(P<0.05)。多因素Logistic回归分析及列线图分析显示多指标影响术后复发,模型预测曲线下面积为0.850(95%CI:0.769~0.932)。结论12导联心电图联合经胸超声心动图综合评估对阵发性房颤患者RFCA术后复发具有较好的预测价值,多因素Logistic回归分析及列线图分析表明,左心房前后径、GLAS、SD-TPS、P波振幅、Pd、Ptf均为患者术后复发的影响因素,基于这些因素构建的模型预测阵发性房颤患者RFCA术后复发的预测价值较高。
Objective To explore the clinical value of the comprehensive evaluation of 12-lead electrocardiogram combined with transthoracic echocardiogram in predicting recurrence after radiofrequency catheter ablation(RFCA).Methods A total of 84 patients with paroxysmal atrial fibrillation who underwent RFCA in Hubei Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively analyzed.They were divided into the recurrence group(n=26)and non-recurrence group(n=58)according to whether recurrence occurred within 1 year of postoperative follow-up.The characteristics of 12-lead electrocardiogram before operation[P wave amplitude,maximum P wave mean time(Pmax),P wave dispersion(Pd),V1 lead P wave terminal potential(Ptf)]were recorded.The transthoracic echocardiography indexes[left ventricular ejection fraction(LVEF),mean value of early diastolic velocity/early diastolic velocity(E/e')of mitral valve orifice,left atrial anteroposterior diameter,left atrial maximum volume,left atrial minimum volume,left atrial ejection fraction(LAEF),global longitudinal strain of left atrial(GLAS),standard deviation of time to peak strain(SD-TPS)normalized by R-R interval]were compared between the two groups.And multivariate Logistic regression analysis and nomogram analysis were performed to establish postoperative recurrence prediction model and verify its predictive value using receiver operating characteristic(ROC)curve.Results The P wave amplitude,Pmax and Pd in the recurrence group were(92.15±5.16)μV,(122.13±6.46)ms and(51.12±4.16)ms,respectively,which were higher than those in the non-recurrence group[(85.44±5.02)μV,(97.48±5.13)ms and(36.99±3.17)ms],Ptf in the recurrence group was(0.02±0.01)ms·s,which was lower than that in the non-recurrence group[(0.04±0.01)ms·s],and the differences were statistically significant(P<0.05).There were no statistically significant differences in LVEF,E/e',left atrial maximum volume,left atrial minimum volume and LAEF between the recurrent group and the non-recurrent group(P>0.05).The left atrial anteroposterior diameter and SD-TPS in the recurrent group were(45.44±3.15)mm and(8.26±2.16)ms,respectively,which were higher than those in the non-recurrent group[(40.16±4.55)mm,(6.22±2.41)ms],and GLAS in the recurrence group was(13.69±6.16)%,which was lower than that in the non-recurrent group[(21.98±6.13)%],the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis and nomogram analyses indicated that multiple indicators influenced postoperative recurrence.The AUC value of the model for predicting postoperative recurrence in patients with paroxysmal atrial fibrillation after RFCA was 0.850(95%CI:0.769-0.932).Conclusion The comprehensive evaluation of 12-lead electrocardiogram combined with transthoracic echocardiogram has a good predictive value for recurrence after RFCA in patients with paroxysmal atrial fibrillation.Multivariate Logistic regression analysis and nomogram analysis indicate that the left atrial anteroposterior diameter,GLAS,SD-TPS,P-wave amplitude,Pd,and Ptf are all influencing factors for postoperative recurrence.The model constructed based on these factors has a high predictive value for recurrence after RFCA in patients with paroxysmal atrial fibrillation.
作者
刘保
程琳
段韵
LIU Bao;CHENG Lin;DUAN Yun(Department of Electrocardiography,Hubei Hospital of Traditional Chinese Medicine,Wuhan Hubei 430000,China;Department of Ultrasound Imaging,Hubei Hospital of Traditional Chinese Medicine,Wuhan Hubei 430000,China)
出处
《临床和实验医学杂志》
2025年第22期2447-2451,共5页
Journal of Clinical and Experimental Medicine
基金
湖北省科技厅重点科技计划项目(编号:2021KJ0210)。
关键词
12导联心电图
经胸超声心动图
射频消融
心律失常
复发
预测
12-lead electrocardiogram
Transthoracic echocardiogram
Radiofrequency catheter ablation
Arrhythmia
Recurrence
Prediction
