| Objective:To investigate the changes in the levels of N-terminal B-type natriuretic peptide(NT-proBNP),matrix metalloproteinase-2(MMP-2)and soluble growth stimulation gene 2(s ST2)in peripheral serum of patients undergoing radiofrequency ablation for atrial fibrillation(AF).To explore the correlation between NT-proBNP,MMP-2,s ST2 and late recurrence after AF radiofrequency ablation,and to provide clinical prediction of recurrenceafter AF.Methods:According to inclusion and exclusion criteria,a total of 77 patients with atrial fibrillation who underwent radiofrequency ablation of atrial fibrillation at the Department of Cardiology of the First Affiliated Hospital of Gannan Medical College from November 2020 to December 2021 were included.And relevant clinical data were collected,including age,gender,type of AF,left atrial diameter(LAD),body mass index(BMI),left ventricular ejection fraction(LVEF),serum globulin,uric acid,glomerular filtration rate,history of smoking,history of alcohol consumption,history of hypertension,and history of diabetes mellitus.All patients were followed up for 12 months after surgery,and NT-proBNP,MMP-2,s ST2 levels were measured before surgery,3 days,1 month,3months,6 months,and 12 months after surgery.Eelectrocardiograms(including ambulatory electrocardiograms)and cardiac ultrasound were also reviewed.Multifactorial logistic regression analysis of risk factors for late recurrence after radiofrequency ablation of atrial fibrillation and construction of Receiver Operating Characteristic(ROC)curves to evaluate the value of serum NT-proBNP,MMP-2,and s ST2 in predicting late recurrence after radiofrequency ablation of atrial fibrillation.Results:1.A total of 77 patients with AF were included,19 in the late recurrence group and 58 in the non-recurrence group,in which the LAD was 45.8±3.5 mm in the recurrence group and 41.3±5.7mm in the non-recurrence group,with statistically significant differences(P=0.002).There are no statistically significant differences between the two groups in terms of age,sex,BMI,uric acid,glomerular filtration rate,LVEF and other clinical data.2.Comparing serum NT-proBNPlevels in the non-relapsed group and relapsed group at different time periods,it was found that NT-proBNP levels were higher in the relapsed group than in the non-relapsed group at all time periods,including(764.3±179.4 pg/m Lin the relapsed group vs 512.2±147.5 pg/m Lin the non-relapsed group),3 days postoperative(713.8±254.7 pg/m Lin the relapsed group vs 485.4 ± 152.7 pg/m L in the non-relapsed group),3 months postoperative(599.6 ±165.8pg/m L in the relapse group vs.336.2 ± 147.1pg/m L in the non-relapse group),6 months postoperatively(548.1±126.1pg/m L in the relapse group vs.236.5±89.4pg/m L in the non-relapse group),and 12 months postoperatively(559.9 ± 119.2pg/m L in the relapse group vs.197.7 ±76.7pg/m Lin the non-relapse group)were statistically different between the two groups(P<0.05).The serum NT-proBNP levels decreased in each time period in the relapse group compared with the preoperative period,but the degree of decrease was small,and none of the differences were statistically significant(P > 0.05).The serum NT-proBNP levels in the non-relapse group were low and decreased significantly in March,June and December after surgery compared with the preoperativeperiod,and thedifferences were statistically significant(P < 0.05).3.Comparing serum MMP-2 levels in the non-relapsed group with the relapsed group at different time periods,we found that the MMP-2 levels in the relapsed group were higher than those in the non-relapsed group at all time periods,including(409.1±176.1ng/m Lin the relapsed group VS 222.7±132.1ng/m L in the non-relapsed group),6 months postoperative(242.4 ±113.1ng/m L in the relapsed group VS 145.7±50.7ng/m L in the non-relapsed group),and 12 months postoperative(254.3±82.3ng/m L in the relapsed group VS 136.3±50.9ng/m L in the non-relapsed group)were statistically different between the two groups(P<0.05).The postoperative serum MMP-2 levels decreased in all time periods in the recurrence group compared to the preoperative period,and the difference was statistically significant(P < 0.05).There was a statistically significant difference in the non-relapse group with low serum MMP-2 levels in March,June and December after surgery compared with the preoperative period(P < 0.05).4.Comparing serum sST2 levels in the non-relapsed group with the relapsed group at different time periods,it was found that s ST2 levels in the relapsed group were significantly higher than those in the non-relapsed group at 12 months postoperatively(250.3±53.2 pg/m Lin the relapsed group vs.134.1±57.9 pg/m L in the non-relapsed group)with statistically significant differences(P < 0.05),and there were no statistical differences in the remaining time periods.Serum s ST2 levels were higher in the recurrence group compared with the preoperative period at all time periods within the group,with no statistical difference(P > 0.05).And serum s ST2 levels were low in the non-recurrence group at 12 months postoperatively compared with the preoperative period with a relatively large decrease,with a statistically significant difference(P < 0.05).5.Multifactorial logistic regression analysis found that LAD(OR=1.184,95 CI 1.013-1.384,P <0.05),preoperative NT-proBNP(OR=1.002,95 CI 1.000-1.003,P < 0.05)and preoperative MMP-2(OR=1.006,95 CI 1.002-1.011,P P < 0.05)had a statistically significant effect on the recurrence of atrial fibrillation.There was no statistical significance in the effect of s ST2 level on the recurrence of atrial fibrillation 12 months aftersurgery(OR=1.009,95 CI 0.996-1.016,P > 0.05).6.The ROC curve was constructed.The area under the ROC curve for preoperative NT-proBNP level to predict late recurrence after RF ablation of AF was 0.659(95% CI 0.511-0.807,P < 0.05)and the best cut-off point to predict recurrence was 1412.5 pg/m L(sensitivity 78.9%,specificity81.0%).The area under the ROC curve for preoperative serum MMP-2The area under the ROC curve for predicting late recurrence after RF ablation of AF was 0.812(95% CI 0.706-0.918,P < 0.05)and the best cut-off point for predicting recurrence was 330.02 ng/m L(sensitivity 68.4%,specificity84.5%).The area under the ROC curve for preoperative NT-proBNP combined with preoperative MMP-2 levels to predict late recurrence after RF ablation of AF was 0.854(95% CI 0.752-0.956,P <0.05).Conclusion:1.The LAD,preoperative serum NT-proBNP,and MMP-2 as independent predictors of late recurrenceafter radiofrequency ablation of atrial fibrillation.2.Preoperative serum NT-proBNP combined with preoperative serum MMP-2 was more valuable than single serum NT-proBNPor MMP-2 inpredicting late recurrence afteratrial fibrillation.3.The sST2 levels were not significantly associated withlaterecurrenceafter atrial fibrillation. |
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