【摘要】 目的 构建并验证一个用于个体化预测持续性心房颤动(房颤)合并心力衰竭(心衰)患者接受导管消融术后1年心功能应答的列线图模型。方法 本研究为单中心回顾性研究。连续纳入2022年1月至2023年12月在河南省人民医院接受首次导管消融治疗的持续性房颤合并心衰(左心室射血分数≤50%)患者254例。根据术后1年超声心动图结果，将患者分为心功能应答组(n=148)与无应答组(n=106)。心功能应答定义为：基线左心室射血分数(LVEF)40%～50%者术后LVEF提升至≥50%,或基线LVEF<40%者术后LVEF绝对值增加≥10%且>40%。通过最小绝对收缩与选择算子(LASSO)回归及多因素Logistic回归筛选独立预测因素，并据此构建列线图模型。采用受试者工作特征曲线(ROC)及曲线下面积(AUC)、Bootstrap法内部验证(1000次重复)、校准曲线和临床决策曲线(DCA)评估模型的区分度、校准度及临床实用性。结果 多因素Logistic回归分析显示，年龄(OR=0.930, 95%CI:0.897～0.964)、房颤病程(OR=0.847, 95%CI:0.753～0.953)、左心房内径(OR=0.917, 95%CI:0.875～0.962)、基线LVEF(OR=1.102, 95%CI:1.044～1.163)和房颤复发(OR=0.381, 95%CI:0.203～0.713)是术后心功能应答的独立预测因素(P<0.05)。基于此五个变量构建的列线图模型，其预测心功能应答的AUC为0.782。内部验证后C统计量为0.766。校准曲线显示模型预测值与实际观测值一致性良好，决策曲线分析表明该模型在广泛的阈值概率范围内具有积极的临床净获益。结论 本研究构建了一个包含年龄、房颤病程、左心房内径、基线LVEF和房颤复发的列线图模型，该模型能有效个体化预测持续性房颤合并心衰患者导管消融术后的心功能应答概率，有助于临床术前决策与患者选择。更多还原

【Abstract】 Objective To develop and validate a nomogram model for individually predicting the probability of cardiac functional response one year after catheter ablation in patients with persistent atrial fibrillation(AF) complicated with heart failure(HF). Methods This single-center retrospective study consecutively enrolled 254 patients with persistent AF and HF(left ventricular ejection fraction, LVEF ≤50%) who underwent their first catheter ablation from January 2022 to December 2023 in Henan Provincial People’s Hospital. Based on echocardiographic results at one-year follow-up, the patients were categorized into a cardiac function response group(n=148) and a non-response group(n=106). Cardiac function response was defined as: LVEF improvement to ≥50% in patients with baseline LVEF of 40%-50%, or an absolute increase in LVEF of ≥10% from baseline resulting in a final LVEF >40% in those with baseline LVEF <40%. The Least Absolute Shrinkage and Selection Operator(LASSO) regression and multivariable Logistic regression were used to identify independent predictors for constructing the nomogram. The model’s discrimination was assessed using the receiver operating characteristic curve and area under the curve(AUC). Internal validation was performed via the bootstrap method(1000 resamples), with calibration curve and decision curve analysis(DCA) used to evaluate calibration and clinical utility, respectively. Results Multivariable Logistic regression analysis identified five independent predictors of cardiac functional response: age(odds ratio OR=0.930, 95% confidence interval CI:0.897-0.964), AF duration(OR=0.847, 95%CI: 0.753-0.953), left atrial diameter(OR=0.917, 95%CI: 0.875-0.962), baseline LVEF(OR=1.102, 95%CI: 1.044-1.163), and post-procedural AF recurrence(OR=0.381, 95%CI: 0.203-0.713)(all P<0.05). The nomogram incorporating these variables demonstrated good discrimination for predicting response, with an AUC of 0.782(95%CI: 0.724-0.840). The internally validated C-statistic was 0.766. The calibration curve showed good agreement between predicted and observed probabilities, and the decision curve analysis indicated a positive net clinical benefit across a wide range of threshold probabilities. Conclusions A nomogram incorporating age, AF duration, left atrial diameter, baseline LVEF, and post-procedural AF recurrence was successfully developed. This model effectively provides individualized prediction of the probability of cardiac functional response after catheter ablation in patients with persistent AF and HF, potentially aiding pre-procedural clinical decision-making and patient selection.更多还原