The Predictive Value Of Serum Uric Acid Combined With Ultrasound Parameters For Recurrence After Radiofrequency Ablation In Patients With Paroxysmal Atrial Fibrillation

Objective : To investigate the correlation between serum uric acid(SUA)and left atrial phase function and left ventricular myocardial layered strain in patients with paroxysmal atrial fibrillation(PAF),and the predictive value of SUA combined with ultrasound parameters for atrial fibrillation recurrence after radiofrequency ablation(RFCA).Methods : A total of 74 patients with PAF who underwent RFCA were selected.The basic clinical data such as gender,age,weight,height,AF course,smoking history,combined diseases(including diabetes,hypertension,hyperlipidemia,etc.)and SUA level were collected.Left atrial anteroposterior diameter(LAD),left ventricular end-diastolic diameter(LVEDD),end-diastolic interventricular septal thickness(IVST),left ventricular posterior wall thickness(PWT),early diastolic peak velocity of mitral flow E peak and early diastolic velocity of mitral interventricular septal annulus and lateral wall annulus(e′),left ventricular ejection fraction(LVEF),left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial total emptying fraction(LAt EF)were measured by echocardiography.Left atrial reservoir strain(LASr),conduit strain(LAScd),pump strain(LASct),left atrial reservoir strain rate(p LASRr),conduit strain rate(p LASRcd),pump strain rate(p LASRct),left ventricular endocardial peak systolic longitudinal strain(GLSendo),midmyocardial peak systolic longitudinal strain(GLSmid)and epicardial peak systolic longitudinal strain(GLSepi)were measured by 2D-STI.According to the level of SUA,the included subjects were grouped.SUA > 420μmol/L was the elevated SUA group,and the rest was the normal SUA group.The differences between the two groups and the correlation with SUA were compared and analyzed.According to the follow-up results,the patients were divided into AF recurrence group and AF non-recurrence group.The differences between the recurrence group and the non-recurrence group of PAF patients with elevated SUA and the recurrence group and the non-recurrence group of PAF patients with normal SUA were compared and analyzed.COX proportional risk regression model was used to determine the independent predictive parameters of recurrence after RFCA in AF patients,and the receiver operating characteristic curve(ROC curve)was drawn to evaluate its predictive value..Results : 1.LAt EF,LASr,LAScd,p LASRr,p LASRcd,p LASRct,GLSendo,GLSmid and GLSepi in the elevated SUA group were significantly lower than those in the normal SUA group(all P< 0.05).The mechanical stiffness LAMS in the elevated SUA group was higher than that in the normal SUA group,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in LAD,E / e ’,LVEDD,IVST,PWT,LVMI,LVEF,LAVmax,LAVmin,LASct and △GLS between the two groups(all P > 0.05).2.In PAF patients with elevated SUA,the ultrasound parameters of the recurrence group group and the non-recurrence group group were compared.The results showed that there were no significant differences in conventional ultrasound parameters(LAD,E/e ’,LVEDD,IVST,PWT,LVEF,LVMI,LAVmax,LAVmin,LAt EF)and ultrasound strain parameters(LASr,LAScd,LASct,p LASRr,p LASRcd,p LASRct,LAMS,GLSendo,GLSmid,GLSepi,△GLS)between the two groups(all P > 0.05).3.In PAF patients with normal SUA,the ultrasound parameters of the recurrence group group and the non-recurrence group were compared.The results showed that there were no significant differences in conventional ultrasound parameters(LAD,E /e ’,LVEDD,IVST,PWT,LVEF,LVMI,LAVmax,LAVmin,LAt EF)and ultrasound strain parameters(LASr,LAScd,LASct,p LASRr,p LASRcd,p LASRct,LAMS,GLSendo,GLSmid,GLSepi,△ GLS)between the two groups(all P > 0.05).4.Correlation analysis showed that SUA level was negatively correlated with LASr,LAScd,p LASRr,p LASRct,GLSendo,GLSmid and GLSepi(all P < 0.05),and positively correlated with mechanical stiffness LAMS(P < 0.05).There was no correlation between SUA and LAt EF,p LASRcd(P > 0.05).5.COX proportional hazard regression model analysis showed that SUA and p LASRct were related to AF recurrence after RFCA(P<0.05),which were risk factors for AF recurrence.Multivariate regression analysis showed that p LASrct was associated with the recurrence of AF after RFCA(P<0.05)and was an independent risk factor for recurrence,while SUA,LASR,LAScd,LAMS,p LASRr,GLSendo,GLSmid and GLSepi could not be used as predictors of AF recurrence(P>0.05).6.ROC curve analysis showed that SUA and p LASRct had predictive value for recurrence of PAF patients after RFCA.When SUA and p LASRct were combined to predict AF recurrence,the area under the curve was 0.774,the sensitivity was 0.733,the specificity was 0.763,and the Youden index was 0.496.Conclusion: 1.High levels of serum uric acid are associated with left atrial remodeling and left ventricular stratified myocardial damage in patients with paroxysmal atrial fibrillation;2.SUA and p LASRcd have predictive value for atrial fibrillation recurrence after radiofrequency ablation,and the combination of the two can improve the predictive efficiency of atrial fibrillation recurrence;3.For patients with atrial fibrillation with high uric acid,attention should be paid to the control of serum uric acid levels to avoid further aggravation of left atrial remodeling and myocardial damage.