The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation.
The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation.
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DOI：
10.1007/s00392-015-0856-x
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
Bollmann A
中科院分区：
文献类型：
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作者：
Kornej J;Hindricks G;Shoemaker MB;Husser D;Arya A;Sommer P;Rolf S;Saavedra P;Kanagasundram A;Patrick Whalen S;Montgomery J;Ellis CR;Darbar D;Bollmann A
高达50%的患者在导管消融术后1年内发生复发性房颤（AF），预测复发的临床风险评分仍然是一个关键的未满足需求。本研究的目的是（1）开发一种用于预测导管消融术后心律结局的简单评分;（2）将其与CHADS 2和CHA 2DS 2-VASc评分进行比较，以及（3）在外部队列中对其进行验证。记录房颤导管消融术后3至12个月的心律结局。APPLE评分[年龄>65岁、持续性房颤、eGFR受损（<60 ml/min/1.73 m2）、左心房直径≥43 mm、EF <50%得1分]与房颤复发相关，并在261例消融和随访情况相当的患者的外部队列中进行了验证。在1145例患者（60 ± 10岁，65%男性，62%阵发性AF）中，APPLE评分显示出比CHADS 2（AUC 0.538）和CHA 2DS 2-VASc（AUC 0.542）更好的AF复发预测（AUC 0.634，95% CI 0.600-0.668，p < 0.001）。与APPLE评分为0的患者相比，APPLE评分为1、2或≥3的患者AF复发的比值比分别为1.73、2.79和4.70（所有p < 0.05）。在外部验证队列中，APPLE评分显示出相似的结果（AUC 0.624，95%CI 0.562-0.687，p < 0.001）。在预测导管消融后心律结果方面，新型APPLE评分优于CHADS 2和CHA 2 DS 2-VASc评分，为上级。它有望成为识别低、中和高房颤复发风险患者的有用工具。
Recurrent atrial fibrillation (AF) occurs in up to 50 % of patients within 1 year after catheter ablation, and a clinical risk score to predict recurrence remains a critical unmet need. The aim of this study was to (1) develop a simple score for the prediction of rhythm outcome following catheter ablation; (2) compare it with the CHADS2 and CHA2DS2-VASc scores, and (3) validate it in an external cohort. Rhythm outcome between 3 and 12 months after AF catheter ablation were documented. The APPLE score [one point for age>65 years, persistent AF, impaired eGFR (<60 ml/min/1.73 m2), LA diameter ≥43 mm, EF < 50 %] was associated with AF recurrence and was validated in an external cohort in 261 patients with comparable ablation and follow-up. In 1145 patients (60 ± 10 years, 65 % male, 62 % paroxysmal AF) the APPLE score showed better prediction of AF recurrences (AUC 0.634, 95 % CI 0.600–0.668, p < 0.001) than CHADS2 (AUC 0.538) and CHA2DS2-VASc (AUC 0.542). Compared to patients with an APPLE score of 0, the odds ratio for AF recurrences was 1.73, 2.79 and 4.70 for APPLE scores 1, 2, or ≥3, respectively (all p < 0.05). In the external validation cohort, the APPLE score showed similar results (AUC 0.624, 95 % CI 0.562–0.687, p < 0.001). The novel APPLE score is superior to the CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcome after catheter ablation. It holds promise as a useful tool to identify patients with low, intermediate, and high risk for AF recurrence.