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Objective To explore establish a risk prediction model for patients with nonvalvular atrial fibrillation (NVAF) after ablation based on serum miRNA levels. Methods A total of 389 NVAF patients who received ablative therapy in the Second Affiliated Hospital of Fujian Medical University from August 2018 to December 2020 were selected as the study objects. 70.0% (272 cases) were randomly selected as the training set, 20.0% (78 cases) as the test set, and 10.0% (39 cases) as the verification set. The patients were followed up for 1 year, and the Kaplan-Meier cumulative recurrence risk curve was drawn. According to the recurrence of patients during the follow-up period, the patients were divided into recurrence group and non-recurrence group. The factors influencing the risk of recurrence after ablation in the training set of NVAF patients were explored through univariate and multivariate analysis, and the prediction model of recurrence risk after ablation was constructed. The prediction efficiency of this model was further tested by the consistency index (C-index) and receiver operating characteristic (ROC) curve. Then the model effectiveness of the test set is verified. Results As of December 21, 2021, a total of 30 cases were lost to follow-up (18 cases in the training set, 10 cases in the test set, and 2 cases in the validation set), and 359 actual cases were finally included (254 cases in training set, 68 in test set, and 37 in validation set). Of which 58 cases recurred in training set, and the recurrence rate was 22.8%. The baseline epicardial adipose tissue (EAT) volume was higher in recurrent group than that in non-recurrent group (P<0.05). The levels of miRNA-21, miRNA-150 and miRNA-192-5p in relapse group before and at the end of follow-up were higher than those in non-recurrence group, while the levels of miRNA-29 were lower than those in non-recurrence group with statistical significance (P<0.05). Multivariate logistic analysis showed that EAT volume (OR=1.060, 95%CI 1.012-1.109), miRNA-192-5p (OR=1.759, 95%CI 1.135-2.726), miRNA-21 (OR=32.508, 95%CI 9.224-114.577), miRNA-150 (OR=18.704, 95%CI 5.513-63.456) are independent risk factors for recurrence after ablation, miRNA-29b (OR=0.166, 95%CI 0.049-0.560) are protective factors for recurrence after ablation (P<0.05). Based on the above factors, the recurrence risk prediction model predicted that the C-index of NVAF patients after ablation was 0.929 (95%CI 0.890-0.958). ROC curve results of verification set showed that the specificity and sensitivity of this model were 83.2% and 88.0%, and the optimal critical value of area under ROC curve (AUC) was 0.711. The test data showed that the sensitivity, specificity and accuracy of the model were 86.7%, 88.7% and 88.3%. Conclusion The post-NVAF ablation recurrence risk model constructed by EAT volume, miRNA-192-5p, miRNA-29b, miRNA-21, miRNA-150 and other factors has a high predictive value for the recurrence risk after NVAF ablation.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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