EHRA症状分层对低CHADS2评分心房颤动患者射频消融术后生活质量改善中的预测价值

摘要

Objective To evaluate the predictors of quality of life (QoL) changes in atrial fibrillation (AF) patients with low CHADS2 score 6 months after radiofrequency ablation(RFA).Methods AF patients with low CHADS2 score (CHADS2 score ＜ 2) undergoing RFA were selected from Chinese Atrial Fibrillation Registry(CAFR) from April 2011 to February 2013.The cohort was then divided into four groups according to their baseline symptoms based on European Heart Rhythm Association(EHRA).We quantified the changes of QoL from baseline to 6 months after RFA using Atrial Fibrillation Effect on QualiTy-of-life(AFEQT) questionnaire.Multivariable linear regression modeling was then conducted to determine predictive factors of the QoL changes from baseline to 6 months after RFA.Results A total of 144 patients with low CHADS2 (61.20±10.12)years old were selected from CAFR.Health status improvement was marked and clinically meaningful during the six months follow-up among the EHRA Ⅱ (23.17,p＜0.001),Ⅲ (32.08,p＜0.001) and Ⅳ (61.73,p=0.004)groups,but no significant difference was seen in the EHRA I.Domain of treatment satisfaction was found to improve statistically significantly but not clinically meaningfully in the following 6 months after RFA in the EHRA Ⅱ (6.22,p=0.03)and Ⅲ(15.06,p＜0.001)groups,but not in the EHRA Ⅰ and Ⅳ groups.The most important predictor for improved health status (OR:2.40,95％ CI:1.32-4.37,p =0.004) and treatment satisfaction (OR:1.95,95 ％ CI:1.02-3.73,p =0.045) after 6 months was EHRA stratification at baseline.Condtsion In most AF patients with low CHADS2 score,QoL was increased in the six months after RFA.Knowledge of the predictors of this increase may aid physicians to timely differentiate between patients who most likely will benefit most from RFA in terms of QoL.%目的 探讨低CHADS2评分心房颤动(房颤)患者经射频消融术(RFA)治疗后生活质量(QoL)变化的预测因素.方法 基于2011年4月至2013年2月间中国房颤注册研究(CAFR)的数据,选取低CHADS2评分(CHADS2评分＜2)且接受RFA治疗的房颤患者,采用房颤特异生活质量量表(AFEQT)评估入选患者基线和RFA术后6个月的QoL.根据欧洲心律协会(EHRA)症状分层标准将入选的房颤患者分成4组,分别比较各组内基线、术后6个月时的QoL的变化.通过多因素回归模型确定基线和术后6个月时房颤患者QoL变化的预测因素.结果 144例低CHADS2评分房颤患者,平均年龄(61.20±10.12)岁,经RFA术后6个月随访时的健康状态与基线相比,2、3、4组的变化分别为23.17(P＜0.001)、32.08(P＜0.001)和61.73(P=0.004),差异具有统计学意义且具有临床意义的改善,而1组无显著变化;6个月时的治疗满意度与基线相比,2和3组的变化分别为6.22(P=0.03)和15.06(P＜0.001),差异具有统计学意义但是临床意义不明显,而1和4组无明显变化.基线EHRA分层是RFA术后6个月内健康状态(OR:2.40,95％ CI:1.32～4.37,P=0.004)和治疗满意度变化(OR:1.95,95％CI:1.02～3.73,P=0.045)的重要预测因素.结论 多数低CHADS2评分房颤患者经RFA治疗后6个月随访时QoL显著提高.了解QoL改善的预测因素有助于医生决定哪些患者从RFA治疗中获益更大.