CAAP-AF评分和APPLE评分对心房颤动合并心力衰竭患者导管消融术后复发的预测价值Predictive value of CAAP-AF scores and APPLE scores on recurrence after catheter ablation of patients with atrial fi brillation and heart failure
杨泽漫,唐立鸿,黄淑萍
摘要(Abstract):
目的探讨CAAP-AF评分和APPLE评分对心房颤动(房颤)合并心力衰竭患者导管消融术后复发的预测价值。方法回顾性分析2017年—2018年在广东省人民医院行导管消融治疗的130例房颤合并心力衰竭患者。根据术后3个月是否发生持续的至少30 s的任何房性心律失常,将患者分为复发组和无复发组。记录所有患者的CAAP-AF评分、APPLE评分、术后12个月内的动态心电图及其他一般资料,对结果进行相应的统计学分析。结果随访12个月发现,共29例(22.3%)患者术后复发。复发组与无复发组的CAAP-AF评分[5(1,9)分比5(1,11)分]及APPLE评分[1(0,5)分比1(0,5)分]比较,差异均无统计学意义(均P>0.05)。生存分析显示,导管消融术后复发与风险评分增加均无显著相关性(Log-rank均P>0.05)。进一步行受试者工作特征曲线分析显示,两种评分预测导管消融术后复发的能力较低,其曲线下面积分别为0.51和0.53。logistic多因素回归分析显示,仅心肌病(OR 4.347,P=0.022)是房颤合并心力衰竭患者导管消融术后复发的独立危险因素。结论 CAAP-AF评分和APPLE评分用于房颤合并心力衰竭患者预测导管消融术后复发的能力有限,尚需要结合其他指标来进一步评估。
关键词(KeyWords): 心房颤动;心力衰竭;导管消融;复发;CAAP-AF评分;APPLE评分
基金项目(Foundation): 2017年广东省医学科研基金(A2017516)
作者(Author): 杨泽漫,唐立鸿,黄淑萍
参考文献(References):
- [1]黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗的建议-2018.中国心脏起搏与心电生理杂志,2018, 32(4):315-368.
- [2] Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med,2018, 378(5):417-427.
- [3] Winkle RA, Jarman JW, Mead RH, et al. Predicting atrial f ibrillation ablation outcome:The CAAP-AF score. Heart Rhythm, 2016, 13(11):2119-2125.
- [4] Kornej J, Hindricks G, Shoemaker MB, et al. The APPLE score:a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation. Clin Res Cardiol, 2015, 104(10):871-876.
- [5] Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrialfibrillation developed in collaboration with EACTS. Europace, 2016, 18(11):1609-1678.
- [6] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC). Developed with the special contribution of the Heart Failure Association(HFA)of the ESC. Eur J Heart Fail, 2016, 18(8):891-975.
- [7]王华,梁延春.中国心力衰竭诊断和治疗指南2018.中华心血管病杂志,2018, 46(10):760-789.
- [8] Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial f ibrillation. Heart Rhythm, 2017, 14(10):e275-e444.
- [9] Deng H, Shantsila A, Xue Y, et al. Using the MB-LATER score for predicting arrhythmia outcome after catheter ablation for atrial fibrillation:The Guangzhou atrial fibrillation project.Int J Clin Pract, 2018, 72(11):e13247.
- [10] Sanhoury M, Moltrasio M, Tundo F, et al. Predictors of arrhythmia recurrence after balloon cryoablation of atrial fibrillation:the value of CAAP-AF risk scoring system. J Interv Card Electrophysiol, 2017, 49(2):129-135.
- [11] Kornej J, Hindricks G, Arya A, et al. The APPLE score-a novel score for the prediction of rhythm outcomes after repeat catheter ablation of atrialfibrillation. PLoS One, 2017, 12(1):e0169933.
- [12] Black-Maier E, Parish A, Steinberg BA, et al. Predicting atrial fibrillation recurrence after ablation in patients with heart failure:Validity of the APPLE and CAAP-AF risk scoring systems. Pacing Clin Electrophysiol, 2019, 42(11):1440-1447.
- [13]杨德彦,高鹏,方全.心房颤动合并心力衰竭患者的导管消融.中国介入心脏病学杂志,2018, 26(12):705-708.
- [14]杨军,陈明龙.心房颤动消融中瘢痕均质化改良:进展与实践.中国介入心脏病学杂志,2017,25(7):413-417.
- [15] Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation:the DECAAF study. JAMA,2014, 311(5):498-506.
- [16] Kornej J, Büttner P, Sommer P, et al. Prediction of electroanatomical substrate using APPLE score and biomarkers.Europace, 2019, 21(1):54-59.
- [17] Prabhu S, Taylor AJ, Costello BT, et al. Catheter ablation versus medical rate control in atrial fibrillation and systolic dysf unction:the CAMERA-MRI study. J Am Coll Cardiol,2017, 70(16):1949-1961.
- [18] Di Biase L, Mohanty P, Mohanty S, et al. Ablation versus amiodarone f or treatment of persistent atrial f ibrillation in patients with congestive heart f ailure and an implanted device:results from the AATAC multicenter randomized trial.Circulation, 2016, 133(17):1637-1644.
- [19] Black-Maier E, Ren X, Steinberg BA, et al. Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction. Heart Rhythm, 2018, 15(5):651-657.
- [20] January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2019, 74(1):104-132.