纤维化-4指数与左心房低电压区和导管消融术后心律失常复发的关系：心房颤动患者的心肝相互作用。

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Arrhythmia Pub Date : 2024-04-28 DOI:10.1002/joa3.13045

Shinya Yamada MD, Takashi Kaneshiro MD, Minoru Nodera MD, Kazuaki Amami MD, Takeshi Nehashi MD, Masayoshi Oikawa MD, Takayoshi Yamaki MD, Kazuhiko Nakazato MD, Takafumi Ishida MD, Yasuchika Takeishi MD

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引用次数: 0

摘要

背景：心房颤动（房颤）中肝纤维化与左心房（LA）重塑之间的关系仍不确定。我们研究了肝纤维化指标纤维化-4（FIB4）指数与电解剖图上 LA 低电压区（LVA）和消融术后房颤复发之间的关系：我们招募了343名接受射频导管消融术（RFCA）或冷冻球囊消融术（CBA）治疗房颤的患者。首先，研究了FIB4指数与LA LVA之间的关联（n = 214）。接着，验证了FIB4指数≥1.3（肝纤维化的推荐临界值）在评估CBA房颤复发风险时的实用性，而无需额外的LVA消融（n = 129）：结果：FIB4指数≥1.3的患者与无FIB4指数的患者相比，LA LVA（>5 cm2）的发生率更高。此外，LVA的定量大小与FIB4指数呈正相关（R = .642，P = 0.039）。在 CBA 中，消融术后 3-12 个月内房颤复发率为 13.1%。在多变量Cox模型中，FIB4指数≥1.3是房颤复发的重要预测因素（危险比3.796；p = .037），这表明LVA可能与CBA后房颤复发有关：结论：FIB4 指数是预测电解剖图上 LA LVA 的存在和 CBA 后房颤复发的新指标。

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Associations of the fibrosis-4 index with left atrial low-voltage areas and arrhythmia recurrence after catheter ablation: cardio-hepatic interaction in patients with atrial fibrillation

Background

The relationship between liver fibrosis and left atrial (LA) remodeling in atrial fibrillation (AF) remains uncertain. We examined the associations between the fibrosis-4 (FIB4) index, an indicator of liver fibrosis, and both LA low-voltage areas (LVAs) on electroanatomic mapping and AF recurrence postablation.

Methods

We recruited 343 patients who underwent radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CBA) for AF. First, the association between the FIB4 index and LA LVAs (<0.5 mV) was evaluated in RFCA using electroanatomic mapping (n = 214). Next, the utility of a FIB4 index ≥1.3, recommended cut-off value of liver fibrosis, was verified to assess the risk for AF recurrence in CBA without additional LVA ablation (n = 129).

Results

Patients with a FIB4 index ≥1.3 had a higher prevalence of LA LVAs (>5 cm²) compared to those without. Additionally, the quantitative size of LVAs showed a positive correlation with the FIB4 index (R = .642, p < .001). In multivariate logistic models, a FIB4 index ≥1.3 was related to the presence of LVAs after adjusting for LA diameter, right atrial end-systolic area, and nonparoxysmal AF (odds ratio 2.508; p = 0.039). In CBA, AF recurrence rate was 13.1% during 3–12 months postablation. In multivariate Cox models, a FIB4 index ≥1.3 was an important predictor of AF recurrence (hazard ratio 3.796; p = .037), suggesting that LVAs might be associated with AF recurrence after CBA.