冠脉重度狭窄与房颤冷冻消融术后复发的相关性研究

doi:10.16150/j.1671-2870.2025.03.012

摘要/Abstract

摘要：

目的：探讨房颤（atrial fibrillation，AF）冷冻消融术前冠状动脉CT血管成像（冠脉）（coronary CT angiography，CCTA）发现的冠脉重度狭窄与消融术后AF复发间的相关性。方法：本研究纳入2021年1月至2022年11月期间，因症状性阵发性或持续性AF入院行首次AF冷冻消融术，并成功进行术前检查CCTA的613例连续病例，按照检出1支以上主要冠脉分支>70%狭窄，将患者分成冠脉重度狭窄组（n=53）和非重度狭窄组（n=560）。所有患者在消融术后定期随访，观察AF复发和手术并发症等安全性终点。采用Kaplan-Meier法评估随访期无AF复发事件生存率，采用多因素Cox回归分析AF消融术后AF复发的预测因子。结果：消融术前CCTA检出冠心病（coronary heart disease，CHD）的患者占22.5%，其中8.6%（53/560）为冠脉重度狭窄。冠脉重度狭窄组在年龄[（69.6±10.3）岁比（62.3±11.9）岁]、持续性房颤占比（59.3%比31.6%）、CHA2DS2-VASC评分[（2.3±1.6）分比（1.5±1.4）分]、左心室射血分数（left ventricular eject fraction，LVEF）[（48.8%±10.3%）比（57.2%±8.9%）]、左心房容量指数（left atrial volume index，LAVI）[（50.3±11.7） mL/m²比（37.0±12.3） mL/m²]及E/A[（1.6±0.4）比（1.1±0.5）]方面，与非重度狭窄组比较有显著差异（P<0.05）。53例经CCTA检出冠脉重度狭窄的患者中，有50例患者（94.3%）是首次被诊断为CHD。中位随访28个月，AF的复发率为20.1%（123/613），其中冠脉重度狭窄组为35.8%（19/53），非重度狭窄组为18.6%（104/560），2组间差异有统计学意义（P<0.05），而2组在安全性终点方面无统计学差异（P>0.05）。Kaplan-Meier生存曲线分析显示，冠脉重度狭窄组的无AF复发事件生存率显著低于非重度狭窄组（71.6%比84.8%，P=0.039）。多变量分析显示，年龄（OR=1.20，95%CI为1.09~1.39，P=0.033）、持续性AF（OR=2.750，95%CI为1.64~5.37，P=0.001）和LAVI（OR=1.14，95%CI为1.10~1.38，P=0.008）是消融术后AF复发的独立预测因子。结论：消融术前检出的冠脉重度狭窄患者无AF复发事件的生存率显著降低，但相较于非重度狭窄患者，冠脉重度狭窄不是冷冻消融术后AF复发的独立预测因子。

关键词: 冷冻消融, 冠状动脉CT血管成像, 冠脉严重狭窄, 房颤复发

Abstract:

Objective To investigate the correlation between severe coronary stenosis detected by coronary CT angio-graphy (CCTA) before cryoablation and atrial fibrillation (AF) recurrence. Methods From January 2021 to November 2022, 613 consecutive patients with symptomatic paroxysmal or persistent AF undergoing first-time cryoablation and successful preprocedural CCTA screening were enrolled. Severe coronary stenosis on CCTA was defined as >70% stenosis in at least one major coronary vessel. Patients were divided into two groups: severe stenosis group (n=53) and non-severe stenosis group (n=560). All patients were regularly followed up after ablation to observe safety endpoints such as AF recurrence and surgical complications. Kaplan-Meier analysis was used to assess AF-free survival rate, and multivariate Cox regression was performed to identify predictors of AF recurrence. Results 22.5% of patients were diagnosed with coronary heart disea-se (CHD), of whom 8.6% (53/560) had severe stenosis on pre-ablation CCTA. Compared to the non-severe stenosis group, the severe coronary stenosis group had higher age [(69.6±10.3) years vs. (62.3±11.9) years], higher prevalence of persistent AF (59.3% vs. 31.6%), higher CHA2DS2 -VASc score (2.3±1.6 vs. 1.5±1.4), lower left ventricular ejection fraction (LVEF) [(48.8%±10.3%) vs. (57.2%±8.9%)], higher left atrial volume index (LAVI) [(50.3±11.7) mL/m² vs. (37.0±12.3) mL/m²], and higher E/A ratio (1.6±0.4 vs. 1.1±0.5) (all P<0.05). Among the 53 patients with severe stenosis detected by CCTA, 50 (94.3%) were newly diagnosed with CHD. After a median follow-up of 28 months, the AF recurrence rate was 20.1% (123/613). The severe stenosis group showed an AF recurrence rate of 35.8% (19/53), significantly higher than the 18.6% (104/560) in the non-severe stenosis group (P<0.05). There was no statistically significant difference in the safety endpoint between the two groups (P>0.05). Kaplan-Meier analysis showed lower AF-free survival rate in the severe stenosis group (71.6% vs. 84.8%, P=0.039). Multivariate Cox regression identified age (OR=1.20, 95%CI: 1.09-1.39, P=0.033), persistent AF (OR=2.750, 95%CI: 1.64-5.37, P=0.001), and LAVI (OR=1.14, 95%CI: 1.10-1.38, P=0.008) as independent predictors of AF recurrence. Conclusions Patients with severe coronary stenosis before ablation screening have lower AF-free survival rate, but severe coronary stenosis itself is not an independent predictor of AF recurrence after cryoablation.

Key words: Cryoablation, Coronary CT angiography, Severe coronary stenosis, Atrial fibrillation recurrence

中图分类号:

罗晓颖, 董凤伟, 许燕, 吴立群, 戚文航. 冠脉重度狭窄与房颤冷冻消融术后复发的相关性研究[J]. 诊断学理论与实践, 2025, 24(03): 328-332.

LUO Xiaoying, DONG Fengwei, XU Yan, WU Liqun, QI Wenhang. Correlation between severe coronary stenosis and recurrence after atrial fibrillation cryoablation[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 328-332.

图/表 2

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Item	severe stenosis （n=53）	non-severe stenosis （n=560）	P value
Age（years）	69.6±10.3	62.3±11.9	<0.001
Male（%）	66.0	60.4	0.431
Body mass index（kg/m²）	28.9±8.1	28.3±9.4	0.205
Hypertension（%）	42.3	39.2	0.242
Diabetes mellitus（%）	11.2	9.3	0.583
Dyslipidaemia（%）	33.7	25.5	0.062
Chronic kidney disease（%）	6.2	4.9	0.124
Heart failure history（%）	11.9	5.5	0.005
Transient ischemic attack or stroke（%）	1.7	2.2	0.223
Persistent AF（%）	59.3	31.6	<0.001
Drugs（%）
Class Ⅰ	13.2	18.4	0.313
Class Ⅱ	26.8	27.5	0.771
Class Ⅲ	42.9	22.7	0.001
Class Ⅳ	1.9	4.8	0.115
CHA₂DS-VAS_C score	2.3±1.6	1.5±1.4	0.026
Heart rate（beats/min）	69	72	0.824
Hemoglobin（g/L）	10.3	9.2	0.662
Creatinin（μmol/L）	118	107	0.133
eGFR（mL/min^-1·1.73 m^-2）	66.5	70.4	0.651
LAVI（mL/m²）	50.3±11.7	37.0±12.3	<0.001
LVEF（%）	48.8±10.3	57.2±8.9	0.011
E/A	1.6±0.4	1.1±0.5	0.044
E/e'	10.1±3.8	9.6±3.2	0.066