心房颤动射频消融术后复发不同预测评分的比较及Nomogram模型的构建

顾怡钰; 杨昕宇; 张铭炀; 徐怡楠; 蒋廷波

doi:10.13201/j.issn.1001-1439.2021.12.012

心房颤动射频消融术后复发不同预测评分的比较及Nomogram模型的构建

- 苏州大学附属第一医院心内科(江苏苏州, 215000)
基金项目:
苏州大学附属第一医院心血管专业组临床试验能力提升(No:201900180019)

江苏干部保健科研课题经费(No:BJ15010)

详细信息

通讯作者: 蒋廷波,E-mail:jtbsdfyy@163.com

中图分类号: R541.7

收稿日期: 2021-07-10

修回日期: 2021-09-17

Comparison among different predictive scores for recurrence of atrial fibrillation after radiofrequency catheter ablation and the construction of a Nomogram model

- Department of Cardiology, The First Affiliated Hospital of Soochow University, Jiangsu, 215000, China

More Information

Corresponding author: JIANG Tingbo, E-mail: jtbsdfyy@163.com

Received Date: 10 July 2021

Revised Date: 17 September 2021

摘要

摘要: 目的:探究心房颤动(房颤)导管射频消融术(RFCA)后复发的相关独立危险因素,建立Nomogram模型,并与已知常用的临床预测评分进行比较。方法:回顾性纳入2018年1月—2020年1月至苏州大学附属第一医院行首次RFCA的房颤患者574例,收集患者基本信息、实验室检查结果、常规心脏彩超资料、术前24 h动态心电图等指标,术后规律随访12个月,记录复发情况。采用R程序中Logistic回归分析RFCA后房颤复发的相关独立危险因素,并建立Nomogram模型。应用Calibration曲线及受试者工作特征曲线(ROC)分析模型预测效能,采用Z检验比较不同模型的预测效能。结果:与未复发组相比,复发组患者房颤病程更长,持续性房颤、合并充血性心力衰竭(心衰)、脑卒中/短暂性脑缺血发作(TIA)、早期复发(ERAF)的患者比例更多;两组估测肾小球滤过率(eGFR)、糖类抗原CA125、左房前后径(LAD)、右房横径(RAD)、肺动脉收缩压均差异有统计学意义(均P<0.05)。多因素Logistic回归显示,LAD>55 mm(OR=5.030,95%CI:1.353~20.035,P=0.017)、eGFR≤60 mL·min^-1·(1.73 m²)^-1(OR=3.104,95%CI:1.530~6.232,P=0.002)、ERAF(OR=6.521,95%CI:3.660~11.821,P<0.001)、充血性心衰(OR=4.350,95%CI:2.404~7.946,P<0.001)、脑卒中/TIA(OR=2.440,95%CI:1.265~4.644,P=0.007)为RFCA术后房颤复发的独立危险因素。构建RFCA后房颤复发的Nomogram预测模型,ROC曲线分析得出模型曲线下面积(AUC)为0.737(95%CI:0.682~0.785),模型截断值为63.9分,灵敏度为0.678,特异度为0.738,预测敏感度及准确度优于CHADS₂、CHA₂DS₂-VASc、HATCH、APPLE、MB-LATER及CAAP-AF评分(均P<0.01)。结论:基于R-Logistic回归建立的Nomogram风险模型对RFCA后房颤复发风险具有中等水平的预测效能,能在一定程度上辅助临床诊疗决策。
- 心房颤动 /
- 导管射频消融术 /
- 复发 /
- Nomogram模型
Abstract: Objective: To explore the independent risk factors related to the recurrence of atrial fibrillation after radiofrequency catheter ablation(RFCA) and establish a Nomogram model to compare it with several commonly used predictive scores.Methods: A total of 574 patients with atrial fibrillation(AF) who underwent RFCA in the First Affiliated Hospital of Soochow University from January 2018 to January 2020 were retrospectively enrolled. The baseline data, serological data, echocardiographic data, and 24-hour dynamic electrocardiogram before surgery were collected. All patients were followed up for 12 months, and the recurrences were recorded. Logistic regression in the R program was used to analyze the independent risk factors of recurrence of atrial fibrillation after RFCA, and a Nomogram model was constructed. The calibration curve and receiver operating characteristic(ROC) analysis were used to validate the efficacy of the Nomogram model, and the Z test was used to compare the efficacy of different models.Results: Compared with the non-recurrence group, patients in the recurrence group had a longer course of atrial fibrillation, a higher proportion of persistent atrial fibrillation, congestive heart failure, stroke/transient ischemic attack(TIA), and early recurrence of atrial fibrillation(ERAF). There were significant differences in estimated glomerular filtration rate(eGFR), CA125, left atrial diameter(LAD), right atrial diameter(RAD), and pulmonary artery systolic pressure between the two groups(all P<0.05). Multivariate Logistic regression showed that LAD>55 mm(OR=5.030, 95%CI: 1.353-20.035, P=0.017), eGFR≤60 mL·min^-1·(1.73 m²)^-1(OR=3.104, 95%CI: 1.530-6.232, P=0.002), ERAF(OR=6.521, 95%CI: 3.660-11.821, P<0.001), congestive heart failure(OR=4.350, 95%CI: 2.404-7.946, P<0.001), stroke/TIA(OR=2.440, 95%CI: 1.265-4.644, P=0.007) were independent risk factors of atrial fibrillation recurrence after RFCA. A Nomogram model was constructed and the ROC curve revealed that the area under the curve(AUC) was 0.737(95%CI: 0.682-0.785), the cutoff value was 63.9 points, and the sensitivity and specificity were 0.678 and 0.738, respectively, which were superior to CHADS₂, HA₂DS₂-VASc, HATCH, APPLE, MB-LATER, and CAAP-AF scores(all P<0.01).Conclusion: The Nomogram model constructed based on the R-Logistic regression has a moderate efficacy to predict the recurrence of atrial fibrillation after RFCA, which is helpful to guide clinical diagnosis and treatment.
- atrial fibrillation /
- radiofrequency catheter ablation /
- recurrence /
- Nomogram model

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