The value of right ventricular function in predicting recurrence after ablation of atrial fibrillation
LIU Ying-xian, CHEN Wei, WANG Jia-li, GAO Peng, CHENG Zhong-wei, FANG Quan, FANG Li-gang
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of
Medical Science and Peking Union Medical College, Beijing 100730, China
摘要目的：探讨右室收缩功能参数对消融术后房颤复发等临床事件的预测价值。方法：前瞻性的队列研究：2013年1月—2015年1月序贯收集北京协和医院心内科55例房颤患者，于射频消融术前行超声心动图，储存动态图像，软件生成左右心室应变曲线。记录治疗方案，随访各种终点事件。结果：射频术后早期复发的房颤患者术前三尖瓣环收缩期纵向位移（（15.9±3.5） mm vs. （18.3±4.2） mm）、右室整体应变（（15.9±3.6）% vs. （20.0±5.0）%）显著低于早期未复发者；右室长轴收缩功能下降（侧壁三尖瓣环收缩期峰速度<10 cm/s或右室整体应变<17%）的房颤患者早期复发率显著高于早期未复发者（P均<0.05）。房颤病程长短、三尖瓣环收缩期纵向位移、右室整体应变均与早期复发显著相关（OR分别为1.039、0.852、0.813，P均<0.05）。多元回归方程校正后仅房颤病程（OR=1.050）及右室整体应变（OR=0.770）为早期复发的独立危险因素（P均<0.05）。右室整体应变与房颤复发（OR=0.802）、心血管事件再入院（OR=0.824）、心律失常相关症状（OR=0.824）均呈负相关。Kaplan-Meier分析中右室整体应变下降的房颤患者消融术后无事件生存率较低（P均<0.05）。结论：右室长轴收缩功能参数下降的房颤患者消融术后更易出现早期复发。右室应变下降对房颤消融术后复发、心血管再入院及心律失常相关临床症状有一定预测价值。
Abstract：Objective: To investigate prognostic values of right ventricular functional parameters in predicting atrial fibrillation(AF) recurrence after ablation. Methods: Perspective cohort study, 55 patients with AF in cardiology department of PUMCH from Jan 2013 to Jan 2015 were involved. Echocardiography was practiced before the radiofrequency ablation surgery. 2D gray scale echocardiography images from 4-chamber view were reserved. Echo-Pac software system was used to generate right and left ventricular time-strain curves. Follow-up was performed every 6 months, and the endpoint events were recorded. Results: AF patients with early recurrence after the ablation manifested as significant decreased tricuspid annular plane systolic excursion(TAPSE) and right ventricular global peak longitudinal strain(RV-PLSS-T). The percentage of early recurrence was obviously elevated in AF patients with RV longitudinal dysfunction(defined as S’<10 cm/s, or RV-PLSS-T<17%)(P<0.05, respectively). Early recurrence of AF were significantly positively correlated with durations of AF, TAPSE and RV-PLSS-T(OR=1.039, 0.852, 0.813, P<0.05, respectively). However, after adjusting in binary logistic model, only course of AF(OR=1.050) and RV-PLSS-T(OR=0.770) were independent risk factors of early recurrence of AF after ablation(P<0.05 respectively). AF patients with decreased RV longitudinal strains showed elevating percentages of endpoint events and shortening event-free survival. Conclusions: AF patients with worse RV longitudinal systolic function were more prone to suffer from early recurrence after ablation. Decreasing RV strains might help to predict endpoint events including AF recurrence, cardiovascular readmission and arrhythmic symptoms.
刘颖娴，陈 未，王佳丽，高 鹏，程中伟，方 全，方理刚. 右室功能对心房颤动消融术后复发的预测价值[J]. 中国临床医学影像杂志, 2019, 30(11): 783-788.
LIU Ying-xian, CHEN Wei, WANG Jia-li, GAO Peng, CHENG Zhong-wei, FANG Quan, FANG Li-gang. The value of right ventricular function in predicting recurrence after ablation of atrial fibrillation. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(11): 783-788.
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