PDF(Pubmed)
Abstract：
BACKGROUND: Atrial fibrillation (AF) is acknowledged as a disease continuum. Despite catheter ablation being recommended as a primary therapy for AF, the high recurrence rates have tempered the initial enthusiasm. Insulin resistance (IR) has been established as an independent predictor for the onset of AF. However, the correlation between non-insulin-based IR indices and late AF recurrence in patients undergoing radiofrequency catheter ablation remains unknown.
METHODS: A retrospective cohort of 910 AF patients who underwent radiofrequency catheter ablation was included in the analysis. The primary endpoint was late AF recurrence during the follow-up period after a defined blank period. The relationship between non-insulin-based IR indices and the primary endpoint was assessed using multivariate Cox hazards regression models and restricted cubic splines (RCS). Additionally, the net reclassification improvement and integrated discrimination improvement index were calculated to further evaluate the additional predictive value of the four IR indices beyond established risk factors for the primary outcome.
RESULTS: During a median follow-up period of 12.00 months, 189 patients (20.77%) experienced late AF recurrence, which was more prevalent among patients with higher levels of IR. The multivariate Cox hazards regression analysis revealed a significant association between these IR indices and late AF recurrence. Among the four indices, METS-IR provided the most significant incremental effect on the basic model for predicting late AF recurrence. Multivariable-adjusted RCS curves illustrated a nonlinear correlation between METS-IR and late AF recurrence. In subgroup analysis, METS-IR exhibited a significant correlation with late AF recurrence in patients with diabetes mellitus (HR: 1.697, 95% CI 1.397 - 2.063, P < 0.001).
CONCLUSIONS: All the four non-insulin-based IR indices were significantly associated with late AF recurrence in patients undergoing radiofrequency catheter ablation. Addressing IR could potentially serve as a viable strategy for reducing the late AF recurrence rate.
METHODS: A retrospective cohort of 910 AF patients who underwent radiofrequency catheter ablation was included in the analysis. The primary endpoint was late AF recurrence during the follow-up period after a defined blank period. The relationship between non-insulin-based IR indices and the primary endpoint was assessed using multivariate Cox hazards regression models and restricted cubic splines (RCS). Additionally, the net reclassification improvement and integrated discrimination improvement index were calculated to further evaluate the additional predictive value of the four IR indices beyond established risk factors for the primary outcome.
RESULTS: During a median follow-up period of 12.00 months, 189 patients (20.77%) experienced late AF recurrence, which was more prevalent among patients with higher levels of IR. The multivariate Cox hazards regression analysis revealed a significant association between these IR indices and late AF recurrence. Among the four indices, METS-IR provided the most significant incremental effect on the basic model for predicting late AF recurrence. Multivariable-adjusted RCS curves illustrated a nonlinear correlation between METS-IR and late AF recurrence. In subgroup analysis, METS-IR exhibited a significant correlation with late AF recurrence in patients with diabetes mellitus (HR: 1.697, 95% CI 1.397 - 2.063, P < 0.001).
CONCLUSIONS: All the four non-insulin-based IR indices were significantly associated with late AF recurrence in patients undergoing radiofrequency catheter ablation. Addressing IR could potentially serve as a viable strategy for reducing the late AF recurrence rate.
摘要：
背景：心房颤动（AF）被认为是一种疾病连续性。尽管导管消融被推荐作为房颤的主要治疗方法,高复发率削弱了最初的热情。胰岛素抵抗（IR）已被确定为房颤发作的独立预测因子。然而,在接受射频导管消融术的患者中,非基于胰岛素的IR指数与房颤晚期复发之间的相关性尚不清楚.
方法：分析纳入了910例接受射频导管消融术的房颤患者的回顾性队列。主要终点是在定义的空白期后的随访期内房颤复发。使用多变量Cox风险回归模型和有限三次样条（RCS）评估非胰岛素IR指数与主要终点之间的关系。此外,计算净重新分类改善和综合辨别改善指数,以进一步评估除确定的主要结局危险因素外,4种IR指数的额外预测价值.
结果：在12.00个月的中位随访期内，189例患者（20.77%）出现晚期房颤复发，在IR水平较高的患者中更为普遍。多变量Cox风险回归分析显示，这些IR指数与房颤晚期复发之间存在显着关联。在四个指数中，METS-IR对预测晚期房颤复发的基本模型提供了最显著的增量效应。多变量调整后的RCS曲线表明METS-IR与晚期房颤复发之间存在非线性相关性。在亚组分析中，METS-IR与糖尿病患者房颤晚期复发呈显著相关(HR:1.697,95%CI1.397-2.063,P<0.001)。
结论：在接受射频导管消融术的患者中，所有四个非基于胰岛素的IR指数均与晚期房颤复发显著相关。解决IR可能是降低房颤晚期复发率的可行策略。
方法：分析纳入了910例接受射频导管消融术的房颤患者的回顾性队列。主要终点是在定义的空白期后的随访期内房颤复发。使用多变量Cox风险回归模型和有限三次样条（RCS）评估非胰岛素IR指数与主要终点之间的关系。此外,计算净重新分类改善和综合辨别改善指数,以进一步评估除确定的主要结局危险因素外,4种IR指数的额外预测价值.
结果：在12.00个月的中位随访期内，189例患者（20.77%）出现晚期房颤复发，在IR水平较高的患者中更为普遍。多变量Cox风险回归分析显示，这些IR指数与房颤晚期复发之间存在显着关联。在四个指数中，METS-IR对预测晚期房颤复发的基本模型提供了最显著的增量效应。多变量调整后的RCS曲线表明METS-IR与晚期房颤复发之间存在非线性相关性。在亚组分析中，METS-IR与糖尿病患者房颤晚期复发呈显著相关(HR:1.697,95%CI1.397-2.063,P<0.001)。
结论：在接受射频导管消融术的患者中，所有四个非基于胰岛素的IR指数均与晚期房颤复发显著相关。解决IR可能是降低房颤晚期复发率的可行策略。
