Novel Method for Risk Stratification of Major Adverse Clinical Events Using Pre- and Post-Ablation Left Atrial Volume Index in Patients With Persistent Atrial Fibrillation.

Circulation reports Pub Date : 2024-09-07 eCollection Date: 2024-10-10 DOI:10.1253/circrep.CR-24-0062
Hironori Ishiguchi, Yasuhiro Yoshiga, Akihiko Shimizu, Masakazu Fukuda, Ayumi Omuro, Masahiro Hisaoka, Yusuke Nakashima, Miho Fujita, Shintaro Hashimoto, Takuya Omuro, Toru Ariyoshi, Shigeki Kobayashi, Takayuki Okamura, Motoaki Sano
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Abstract

Background: The relationship between changes in the left atrial volume index (LAVI) post-catheter ablation (CA) and long-term prognostic events in patients with persistent atrial fibrillation (AF) remains unclear. We evaluated the incidence of major adverse clinical events (MACE), including all-cause death, unplanned heart failure hospitalization, and unplanned cardiovascular hospitalization using pre- and post-CA LAVI.

Methods and results: We collected data retrospectively from 150 patients with persistent AF who underwent their first CA. LAVI was calculated during preprocedural echocardiography under AF rhythm (pre-CA LAVI) and 3 months post-CA under sinus rhythm (post-CA LAVI). The cumulative incidence of MACE was compared among 3 subgroups based on the cutoff values of pre-CA (45.5 mL/m2) and post-CA (46.5 mL/m2; both determined using the c-statistic) LAVI. The subgroup of a pre-CA LAVI >45.5 mL/m2 with a post-CA LAVI >46.5 mL/m2 (n=45) had a significantly higher MACE incidence compared with other subgroups (P=0.002). Multivariate analysis identified this subgroup as independently at higher risk for MACE. The subgroup of a pre-CA LAVI >45.5 mL/m2 with a post-CA LAVI ≤46.5 mL/m2 (n=49) had an incidence comparable with those with pre-CA LAVI ≤45.5 mL/m2 (n=56) and exhibited a significantly greater reduction in LAVI than other subgroups did (P<0.001).

Conclusions: Combining pre-CA and post-CA LAVIs is valuable in stratifying long-term MACE development risk following CA.

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利用持续性心房颤动患者消融前和消融后左心房容积指数对主要不良临床事件进行风险分层的新方法
背景:导管消融术(CA)后左心房容积指数(LAVI)的变化与持续性心房颤动(AF)患者长期预后事件之间的关系仍不清楚。我们利用消融前后的 LAVI 评估了主要不良临床事件(MACE)的发生率,包括全因死亡、非计划性心衰住院和非计划性心血管住院:我们回顾性地收集了150名首次接受CA的持续性房颤患者的数据。在心房颤动节律(心房颤动前 LAVI)和窦性心律(心房颤动后 LAVI)的情况下,分别计算心房颤动术前超声心动图和心房颤动术后 3 个月的 LAVI。根据手术前 LAVI 临界值(45.5 mL/m2)和手术后 LAVI 临界值(46.5 mL/m2;均采用 c 统计量),比较了 3 个亚组的 MACE 累积发生率。与其他亚组相比,CA 前 LAVI >45.5 mL/m2 后 LAVI >46.5 mL/m2 的亚组(n=45)MACE 发生率明显更高(P=0.002)。多变量分析确定该亚组发生 MACE 的风险较高。CA前LAVI>45.5 mL/m2、CA后LAVI≤46.5 mL/m2的亚组(n=49)的发病率与CA前LAVI≤45.5 mL/m2的亚组(n=56)相当,且LAVI的下降幅度明显高于其他亚组(PConclusions:结合CA前和CA后的LAVI对分层CA后长期MACE发生风险很有价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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