| Objective: Echocardiography is one of the most accessible tests in patients with atrial fibrillation,preoperative echocardiography of patients with atrial fibrillation,measurement of echocardiographic parameters and follow-up of patients,to clarify the predictive value of preoperative echocardiographic indicators for sinus rhythm maintenance after RFCA in patients with atrial fibrillation.Methods:A total of 46 patients with atrial fibrillation who underwent RFCA for the first time were consecutively enrolled as the research subjects,and collect the baseline data of the patients,such as gender,age,height,weight,basic heart rate,CHA2DS2-VASc score,HAS-BLED score,NT-ProBNP,diseases（Such as hypertension,diabetes,cerebrovascular disease,etc.）,drug types,etc.;collect the echocardiographic data of patients,such as LVEF,LAEF,LAD,LVEDD,LAVmax,PWth,IVSth and other indicators,and calculate E/e’,RWT,LVMI,LAVImax according to the formula;use 2D-STI technology to manually delineate ROI,record LASRs,LASRe,LASRa,LVGLS and other indicators.According to the type of atrial fibrillation,the included research subjects were divided into PAF group and PeAF group,and the follow-up time was at least 6months,and they were divided into RAF group and NRAF group according to the follow-up results.The differences between the RAF group and the NRAF group,the RAF group and the NRAF group in the PAF patients,the RAF group and the NRAF group in the PeAF patients were analyzed by univariate regression analysis and multivariate COX proportional hazards regression to analyze the predictors of recurrence after RFCA,and the ROC curve was drawn.Results: 1.Comparison of basic data between PAF group and PeAF group:NT-ProBNP in PeAF group was significantly higher than that in PAF group,and there was a significant difference between the two groups.（PAF 196.50（89.25-535.00）vs.PeAF 594.50（362.25-1187.500）,P=0.001）,and there were no significant differences in other indicators between the two groups.2.Comparison of echocardiographic data between PAF group and PeAF group:LAEF in PAF group was significantly higher than that in PeAF group,and there was a statistically significant difference between the two groups（PAF 44.00±9.06 vs.PeAF35.41±7.35,P=0.002）;PeAF group had significantly higher LAD Higher than the PAF group,there was a statistically significant difference between the two groups（PAF 3.41±0.37 vs.PeAF 3.92±0.47,P=0.001）;E/e’ in the PeAF group was significantly higher than that in the PAF group,and there was a significant difference between the two groups（PAF 3.92±0.47,P=0.001）.7.36±1.75 vs.PeAF 9.02±2.30,P<0.01);strain parameters LASRs in PAF group（PAF 1.24±0.50 vs.PeAF 0.59±0.28,P=0.000）,LASRe（PAF-0.80[-1.24～-0.56] vs..PeAF-0.34[-0.71～-0.12],P=0.001）,LASRa（PAF-1.24±0.65 vs.PeAF-0.47±0.28,P=0.000）,LVGLS（PAF-18.99±3.47 vs.PeAF-14.91± 4.21,P=0.001）were higher than the strain parameters in PeAF group,and there were significant differences（P<0.01）.3.Comparison of echocardiographic data between RAF and NRAF in patients with PAF: LVEDD in the RAF group was higher than that in the NRAF group（NRAF4.54[4.29～4.77] vs.RAF 4.86[4.81～5.35],P=0.020）;4.Comparison of echocardiographic data between RAF and NRAF in PeAF patients: There was no significant difference in echocardiographic indexes between RAF group and NRAF group in PeAF patients（P>0.05）.5.Univariate and multivariate COX proportional hazards regression analysis:NT-PROBNP,LAD,LVEDD,LVMI,LASRs,LASRe,LASRa,LVGLS,etc.were used as predictors of atrial fibrillation recurrence after RFCA for univariate regression analysis,LVEDD（HR=5.303,95%CI 1.030-27.299,P=0.046）、LASRa（HR=3.599,95%CI 0.787～16.469,P=0.049）were associated with AF recurrence;multivariate COX proportional hazards regression suggested NT-PROBNP（HR=0.996,95%CI0.992-0.999,P=0.025）,LAD（HR=142.439,95%CI 2.571～7.89*10^3,P=0.015）,LVEDD（HR=713.389,95%CI 4.026～1.26*10^5,P=0.013）,LVMI（HR=0.954,95%CI 0.911-1.000,P=0.048）,LVGLS（HR=1.384,95%CI 1.032-1.859,P=0.030）were predictors of AF recurrence.6.ROC curve analysis showed that the area under the curve of LVEDD was AUC=0.765（95%CI 0.618～0.912,P=0.20）,and the critical value of LVEDD was4.61,which had predictive value for the recurrence of atrial fibrillation after RFCA,with a sensitivity of 100%,the specificity was 57.9%,the Youden index was 0.579;the area under the curve of LASRa was AUC=0.737（95%CI 0.517-0.956,P=0.037）,and the critical value of LASRa was-0.53.Predictive value,the sensitivity was 75%,the specificity was 73.7%,and the Youden index was 0.487.Conclusion: 1.Differences between the groups of PAF and PeAF patients showed significant differences in NT-ProBNP,LAEF,LAD,E/e’,LASRs,LASRe,LASRa,LVGLS and other indicators;2.Differences between RAF and NRAF groups in PAF patients,PeAF patients There was no significant difference between RAF and NRAF groups;3.LVEDD and LASRa had predictive effects on the recurrence of atrial fibrillation after RFCA,and were independent predictors of the recurrence of atrial fibrillation after RFCA. |
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