Abstract：
OBJECTIVE: Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). The impact of ST-segment depression before CA on LVEF recovery and clinical outcomes remains unknown. In the present study, we aimed to investigate the relationship between ST-segment depression during AF rhythm before CA and improvement in the LVEF and clinical outcomes in persistent atrial fibrillation (PerAF) patients with HFrEF.
RESULTS: The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF < 50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1 month were not included in the enrolled patients. We assigned the patients based on the presence of ST-segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF ≥ 15%) 1 year after CA and the relationship between ST-segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1 year after CA was significantly lower in the patients with ST-segment depression than those without (58.6% vs. 79.7%, P = 0.012). Multiple regression analysis showed ST-segment depression was independently and significantly associated with improvement in the LVEF 1 year after CA (HR: 0.35; 95% CI: 0.129-0.928, P = 0.035). Kaplan-Meier analysis showed that the patients with ST-segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P = 0.022 and log rank P = 0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST-segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210-6.584, P = 0.016).
CONCLUSIONS: ST-segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF.
RESULTS: The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF < 50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1 month were not included in the enrolled patients. We assigned the patients based on the presence of ST-segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF ≥ 15%) 1 year after CA and the relationship between ST-segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1 year after CA was significantly lower in the patients with ST-segment depression than those without (58.6% vs. 79.7%, P = 0.012). Multiple regression analysis showed ST-segment depression was independently and significantly associated with improvement in the LVEF 1 year after CA (HR: 0.35; 95% CI: 0.129-0.928, P = 0.035). Kaplan-Meier analysis showed that the patients with ST-segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P = 0.022 and log rank P = 0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST-segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210-6.584, P = 0.016).
CONCLUSIONS: ST-segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF.
摘要：
目的：心房颤动（AF）的导管消融（CA）改善了射血分数（HFrEF）降低的心力衰竭患者的左心室射血分数（LVEF）。CA前ST段压低对LVEF恢复和临床结果的影响尚不清楚。在本研究中,本研究的目的是研究持续性房颤(PerAF)伴HFrEF患者在CA前房颤节律期间ST段压低与LVEF改善及临床结局之间的关系.
结果：本研究包括122例PerAF患者（男性；98例，80%,平均年龄：69[56,76]岁），来自LVEF<50％并接受初始消融的大阪Rosai房颤消融（ORAF）注册表。在过去1个月内接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的患者不包括在入选患者中。我们根据房颤节律期间CA前是否存在ST段压低对患者进行分组，并评估CA后1年LVEF(LVEF≥15%)的改善情况，以及ST段压低与心力衰竭(HF)住院/主要不良心血管事件(MACE)之间的关系。它们被定义为HF住院治疗的复合物，心血管死亡,因冠状动脉疾病住院，需要住院和中风的室性心律失常。在ST段压低的患者中，CA后1年LVEF改善的患者百分比显着低于无ST段压低的患者（58.6％vs.79.7%,P=0.012)。多元回归分析显示，ST段压低与CA后1年LVEF的改善独立且显着相关（HR：0.35；95％CI：0.129-0.928，P=0.035）。Kaplan-Meier分析显示，ST段压低患者的HF住院和MACE风险明显高于无ST段压低患者（logrankP=0.022和logrankP=0.002）。多变量Cox比例风险分析显示，ST段压低与MACE的高风险独立且显着相关（HR：2.82；95％CI：1.210-6.584，P=0.016）。
结论：在伴有HFrEF的PerAF患者中，心律期间CA前ST段压低是改善LVEF和临床结局（包括HF住院和MACE）的有用预后预测因子。
结果：本研究包括122例PerAF患者（男性；98例，80%,平均年龄：69[56,76]岁），来自LVEF<50％并接受初始消融的大阪Rosai房颤消融（ORAF）注册表。在过去1个月内接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的患者不包括在入选患者中。我们根据房颤节律期间CA前是否存在ST段压低对患者进行分组，并评估CA后1年LVEF(LVEF≥15%)的改善情况，以及ST段压低与心力衰竭(HF)住院/主要不良心血管事件(MACE)之间的关系。它们被定义为HF住院治疗的复合物，心血管死亡,因冠状动脉疾病住院，需要住院和中风的室性心律失常。在ST段压低的患者中，CA后1年LVEF改善的患者百分比显着低于无ST段压低的患者（58.6％vs.79.7%,P=0.012)。多元回归分析显示，ST段压低与CA后1年LVEF的改善独立且显着相关（HR：0.35；95％CI：0.129-0.928，P=0.035）。Kaplan-Meier分析显示，ST段压低患者的HF住院和MACE风险明显高于无ST段压低患者（logrankP=0.022和logrankP=0.002）。多变量Cox比例风险分析显示，ST段压低与MACE的高风险独立且显着相关（HR：2.82；95％CI：1.210-6.584，P=0.016）。
结论：在伴有HFrEF的PerAF患者中，心律期间CA前ST段压低是改善LVEF和临床结局（包括HF住院和MACE）的有用预后预测因子。
