额面QRS-T夹角和TyG指数在持续性心房颤动患者导管消融术后晚期复发的预测价值

Predictive Value of Frontal QRS-T Angle and TyG Index for Late Recurrence after Catheter Ablation in Patients with Persistent Atrial Fibrillation

摘要: 目的：探讨额面QRS-T夹角和甘油三酯葡萄糖指数在持续性心房颤动患者导管消融术后晚期复发方面的临床意义及应用价值。方法：本研究是一项单中心、回顾性、队列研究，回顾性收集了2023年1月至2024年12月于成都市第一人民医院就诊行导管消融术的持续性心房颤动患者资料，根据术后3月是否复发分为复发组和未复发组，收集患者一般临床资料和相关实验室检查，并计算术前额面QRS-T夹角和TyG指数，通过单因素及多因素COX比例风险回归模型分析该类患者术后晚期复发的危险因素，受试者工作特征(ROC)曲线分析额面QRS-T夹角和TyG指数预测房颤晚期复发的价值。结果：一共纳入80例患者，复发组(32例)和未复发组(48例)，单因素分析得到额面QRS-T夹角、TYG指数、左心房直径和空腹血糖有统计学意义(P < 0.05)，且与未复发组相比，复发组左心房直径(42.48 ± 7.499, 35.58 ± 5.199, P = 0.009)、额QRS-T夹角(96.69 ± 53.708, 57.00 ± 46.652, P < 0.01)和TyG指数高于未复发组(1.245 ± 0.469, 1.022 ± 0.474, P < 0.05)；经过多因素Logistic回归分析结果显示，额面QRS-T夹角[OR = 1.019, 95% CI (1.007, 1.031), P = 0.001]和TyG指数[OR = 6.266, 95% CI (1.656, 23.715), P = 0.007]是持续性心房颤动导管消融术后房颤复发的影响因素。ROC曲线分析结果显示，额面QRS-T夹角和TyG指数预测该类患者术后房颤复发的曲线下面积(AUC)为0.824 (95% CI: 0.733~0.915, P < 0.001)。结论：QRS-T夹角和TyG指数是持续性心房颤动患者导管消融术后房颤晚期复发的危险因素。

Abstract: Objective: To explore the clinical significance and application value of the frontal QRS-T angle and the Triglyceride-Glucose (TyG) index in predicting late recurrence after Radiofrequency Catheter Ablation (RFCA) in non-diabetic patients with Persistent Atrial Fibrillation (PeAF). Methods: This study is a single-center, retrospective cohort study. The clinical data were retrospectively reviewed of 80 PeAF patients, who received RFCA for the first time at the First People’s Hospital of Chengdu from January 2023 and December 2024. Patients were divided into a recurrence group and a non-recurrence group based on whether they experienced a recurrence three months after the procedure. General clinical data and relevant laboratory test results were collected for all patients. Preoperative frontal plane QRS-T angle and TyG index were calculated. Univariate and multivariate Logistic proportional hazards regression models were used to analyze the risk factors for late postoperative recurrence in this patient population. The predictive value of the frontal plane QRS-T angle and the TyG index for late atrial fibrillation recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 80 patients were included, comprising a recurrence group (n = 32) and a non-recurrence group (n = 48). Univariate analysis revealed that the frontal QRS-T angle, TyG index, left atrial diameter, and fasting blood glucose were statistically significant (P < 0.05). Compared with the non-recurrence group, the recurrence group exhibited higher left atrial diameter (42.48 ± 7.499 vs 35.58 ± 5.199, P = 0.009), higher frontal QRS-T angle (96.69 ± 53.708 vs 57.00 ± 46.652, P < 0.01), and higher TyG index (1.245 ± 0.469 vs 1.022 ± 0.474, P < 0.05). Multivariate Logistic regression analysis showed that the frontal QRS-T angle [OR = 1.019, 95% CI (1.007, 1.031), P = 0.001] and TyG index [OR = 6.266, 95% CI (1.656, 23.715), P = 0.007] were independent predictors for recurrence. ROC curve analysis indicated that the Area Under the Curve (AUC) for predicting postoperative recurrence using the frontal QRS-T angle and TyG index was 0.824 (95% CI: 0.733~0.915, P < 0.001). Conclusion: The frontal QRS-T angle and TyG index are risk factors for late recurrence after RFCA in PeAF patients.