冠周脂肪及甘油三酯-葡萄糖指数对不同类型心房颤动射频消融术后复发的预测价值

李晓乐; 谢丽响; 严卉; 陈文苏; 李承宗; 王子硕; 陈广义; 王思怡; 张银洋; 胡春峰

doi:10.13201/j.issn.1001-1439.2024.08.013

冠周脂肪及甘油三酯-葡萄糖指数对不同类型心房颤动射频消融术后复发的预测价值

- 1.
  徐州医科大学附属医院放射科(江苏徐州，221002)
- 2.
  徐州医科大学附属医院心内科
- 3.
  睢宁县人民医院放射科
- 4.
  徐州医科大学医学影像学院
基金项目:
徐州市重点研发计划(社会发展)项目(No：KC22248)

详细信息

通讯作者: 胡春峰，E-mail：hcfxz@163.com

中图分类号: R541.7

收稿日期: 2024-05-16

刊出日期: 2024-08-13

The predictive value of pericoronary adipose tissue and TyG index on recurrence after radiofrequency ablation in patients with different types of atrial fibrillation

- 1.
  Department of Radiology
- 2.
  Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, China
- 3.
  Department of Radiology, Suining County People's Hospital
- 4.
  School of Medical Imaging, Xuzhou Medical University

More Information

Corresponding author: HU Chunfeng, E-mail: hcfxz@163.com

Received Date: 16 May 2024

Publish Date: 13 August 2024

摘要

摘要: 目的探究冠周脂肪(PCAT)及甘油三酯-葡萄糖(TyG)指数对不同类型心房颤动(房颤)患者射频消融术(RFCA)后复发的影响。方法回顾性分析2018年8月—2022年12月首次且成功行RFCA的360例患者，分为持续性房颤(PersAF)组153例，及阵发性房颤(PAF)组207例，定期随访复发情况，根据术前冠状动脉CT血管成像(CCTA)测量PCAT相关参数，采集患者术前一般资料并计算TyG指数，比较两组患者临床及影像资料与复发情况。Cox回归分析复发的影响因素，受试者工作特征(ROC)曲线计算诊断效能。结果中位随访11.5个月后，87例患者复发，其中PersAF组47例，PAF组40例。多因素Cox回归分析显示，左回旋支脂肪衰减指数(LCX-FAI)为PersAF患者复发的独立危险因素(P < 0.001)；TyG指数为PersAF及PAF患者术后复发的独立危险因素(P < 0.001)。LCX-FAI、TyG指数预测PersAF患者术后复发曲线下面积(AUC)分别为0.898、0.892，二者联合AUC为0.951。TyG指数预测PAF患者术后复发的AUC为0.842。结论 TyG指数是PAF患者术后复发的独立危险因素，LCX-FAI和TyG指数可预测PersAF患者术后复发，二者联合预测价值更高。
- 冠周脂肪 /
- 脂肪衰减指数 /
- 甘油三酯-葡萄糖指数 /
- 心房颤动 /
- 射频消融术
Abstract: Objective To investigate the effects of pericoronary fat(PCAT) and triglyceride glucose(TyG) index on recurrence after radiofrequency ablation(RFCA) in patients with different types of atrial fibrillation(AF).Methods A retrospective analysis was performed in 360 patients who underwent RFCA for the first time from August 2018 to December 2022. They were divided into 153 patients in the persistent atrial fibrillation(PersAF) group and 207 patients in the paroxysmal atrial fibrillation(PAF) group. The recurrence situation was regularly followed up, and PCAT related parameters were measured according to preoperative coronary CT angiography(CCTA). Preoperative general data of patients were collected and TyG index was calculated. Cox regression analysis was performed to analyze the influence factors of recurrence, and receiver operating characteristic(ROC) was used to calculate the diagnostic efficiency.Results After a median follow-up of 11.5 months, 87 patients recurred, including 47 patients in the PersAF group and 40 patients in the PAF group. Multivariate Cox regression analysis showed that LCX-FAI was an independent risk factor for recurrence in PersAF patients(P < 0.001). TyG index was an independent risk factor for postoperative recurrence in PersAF and PAF patients(P < 0.001). AUC of LCX-FAI and TyG index in PersAF patients were 0.898 and 0.892, respectively, and the combined AUC was 0.951. AUC of TyG index in PAF patients was 0.842.Conclusion TyG index is an independent risk factor for postoperative recurrence in patients with PAF. LCX-FAI and TyG index can effectively predict postoperative recurrence in patients with PersAF.
- pericoronary adipose tissue /
- fat attenuation index /
- triglyceride-glucose index /
- atrial fibrillation /
- radiofrequency catheter ablation

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图 1 后处理软件半自动测量LAD周围脂肪组织体积和衰减指数

Figure 1. Measurement of the adipose tissue volume and fat attenuation index surrounding the left anterior descending artery

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图 2 两组LCX-FAI、TyG指数比较箱线图

Figure 2. Box plot of LCX-FAI and TyG index

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图 3 PersAF患者RFCA后复发的单因素Cox回归分析

Figure 3. Univariate Cox regression analysis of the recurrence in patients with PersAF

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图 4 PAF患者RFCA后复发的单因素Cox回归分析

Figure 4. Univariate Cox regression analysis of the recurrence in patients with PAF

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图 5 房颤患者RFCA后复发危险因素的预测效能评估

Figure 5. Evaluation of predictive efficacy of risk factors for postoperative recurrence

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表 1 PersAF组和PAF组临床资料及PCAT参数比较

Table 1. Comparison of clinical data and PCAT parameters 例(%), X±S, M(P₂₅, P₇₅)

项目	PersAF组(153例)	PAF组(207例)	χ²/Z/t	P
男	103(67.32)	114(55.07)	5.512	0.019
年龄/岁	59.31±9.74	61.79±9.92	2.363	0.019
BMI/(kg/m²)	25.51(23.83，27.10)	24.62(23.44，26.54)	-1.849	0.064
高血压	66(43.14)	93(44.93)	0.114	0.735
吸烟史	46(30.07)	36(17.39)	8.034	0.005
糖尿病	8(9.20)	34(12.45)	0.080	0.410
总胆固醇/(mmol/L)	4.16±1.07	4.32±0.93	1.526	0.128
甘油三酯/(mmol/L)	1.32(0.98，1.89)	1.37(1.08，1.84)	-0.164	0.870
TyG指数	8.77±0.74	8.66±0.56	-1.537	0.125
高密度脂蛋白/(mmol/L)	1.07±0.27	1.09±0.29	0.625	0.532
低密度脂蛋白/(mmol/L)	2.38(1.96，2.92)	2.61(1.98，3.21)	-1.737	0.082
CHA₂DS₂-VASc评分/分	2(1，3)	2(1，3)	-0.972	0.331
LAD-V/cm³	1.31(1.08，1.54)	1.29(1.02，1.54)	-0.122	0.903
LAD-FAI/HU	-79(-86，-75)	-79(-86，-74)	-0.624	0.532
LCX-V/cm³	1.36(1.15，1.68)	1.37(1.13，1.68)	-0.017	0.987
LCX-FAI/HU	-81.44±10.60	-84.74±10.00	-3.010	0.003
RCA-V/cm³	1.49(1.23，1.78)	1.49(1.25，1.76)	-0.152	0.879
RCA-FAI/HU	-83.92±10.95	-83.72±10.81	0.164	0.870
CHA₂DS₂-VASc评分：非瓣膜性房颤脑卒中危险因素评分；LAD-V：左前降支周围脂肪组织体积；FAI：脂肪衰减指数；LCX-V：左回旋支周围脂肪组织体积；RCA-V：右冠脉周围脂肪组织体积。

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表 2 PersAF与PAF患者RFCA后复发的多因素Cox回归分析

Table 2. Multivariate Cox regression analysis of the recurrence in patients with PersAF and PAF

项目	B	SE	Z	HR	95%CI	P	VIF
PersAF
LCX-FAI	0.085	0.020	4.355	1.089	1.048~1.132	< 0.001	1.266
TyG指数	0.830	0.215	3.859	2.293	1.504~3.496	< 0.001	1.266
PAF
甘油三酯	0.153	0.145	1.052	1.165	0.877~1.548	0.293
TyG指数	1.634	0.255	6.402	5.123	3.107~8.448	< 0.001

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表 3 PersAF与PAF患者术后复发危险因素的ROC曲线分析

Table 3. ROC curve analysis of risk factors for postoperative recurrence

项目	最佳阈值	灵敏度/%	特异度/%	AUC(95%CI)
PersAF
LCX-FAI	-75.5 HU	78.7	88.7	0.898(0.845~0.950)
TyG指数	9	83.0	68.8	0.892(0.836~0.949)
二者联合		89.4	92.5	0.951(0.916~0.986)
PAF
TyG指数	8.815	80.0	75.4	0.842(0.779~0.906)

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