Addition of B-Type Natriuretic Peptide to Existing Clinical Risk Scores Enhances Identification of Patients at Risk for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.
Addition of B-Type Natriuretic Peptide to Existing Clinical Risk Scores Enhances Identification of Patients at Risk for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.
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DOI：
10.1097/hpc.0000000000000060
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发表时间：
2015-12
影响因子：
--
通讯作者：
McManus DD
中科院分区：
文献类型：
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作者：
Shaikh AY;Esa N;Martin-Doyle W;Kinno M;Nieto I;Floyd KC;Browning C;Ennis C;Donahue JK;Rosenthal LS;McManus DD
预测哪些患者在肺静脉隔离（PVI）后将免于房颤（AF）仍然具有挑战性。临床风险预测评分显示识别肺静脉隔离术后房颤复发风险患者的能力中等。B型利钠肽（BNP）与AF事件和复发风险相关，但目前未纳入现有AF风险评分。我们试图评估将术前BNP添加到现有风险评分中以预测肺静脉隔离术后6个月内房颤复发的增量获益。2010年至2013年期间，161例阵发性或持续性AF患者接受了首次肺静脉隔离手术;在6个月的随访期内，77例患者（48%）在肺静脉隔离后（肺静脉隔离后> 3个月）出现晚期AF复发。在多变量分析中，BNP ≥ 100 pg/dL（p = 0.01）和PVI后3个月内AF复发（p <0.001）与晚期AF复发相关。将BNP添加到现有临床风险评分中显著改善了每个评分的曲线下面积（AUC），综合区分改善（IDI）为0.08（p = 0.001）;所有风险评分的净重新分类改善（NRI）为60%（p = 0.001）。循环BNP水平与肺静脉隔离术后晚期房颤复发独立相关。纳入BNP可显著提高CHADS 2、CHA2DS 2-VASc、R2CHADS 2和HATCH评分在预测肺静脉隔离后具有临床意义的晚期AF复发方面的区分能力，应将其纳入AF管理的决策算法中。B-R2CHADS 2是预测晚期AF复发的最佳评分模型。
Predicting which patients will be free from atrial fibrillation (AF) after pulmonary vein isolation (PVI) remains challenging. Clinical risk prediction scores show modest ability to identify patients at risk for AF recurrence after PVI. B-type natriuretic peptide (BNP) is associated with risk for incident and recurrent AF, but is not currently included in existing AF risk scores. We sought to evaluate the incremental benefit of adding pre-operative BNP to existing risk scores for predicting AF recurrence during the 6 months after PVI. 161 patients with paroxysmal or persistent AF underwent an index PVI procedure between 2010 and 2013; 77 patients (48%) had late AF recurrence after PVI (>3 months post-PVI) over the 6-month follow-up period. A BNP ≥100 pg/dL (p = 0.01) and AF recurrence within 3-months post-PVI (p<0.001) were associated with late AF recurrence in multivariate analyses. Addition of BNP to existing clinical risk scores significantly improved the areas under the curve (AUC) for each score, with an integrated discrimination improvement (IDI) of 0.08 (p=0.001); and a net reclassification improvement (NRI) of 60% (p=0.001) for all risk scores. Circulating BNP levels are independently associated with late AF recurrence after PVI. Inclusion of BNP significantly improves the discriminative ability of CHADS2, CHA2DS2-VASc, R2CHADS2, and the HATCH score in predicting clinically significant, late AF recurrence after PVI and should be incorporated in decision making algorithms for management of AF. B-R2CHADS2 is the best score model for prediction of late AF recurrence.