Construction of Nomogram prediction model for recurrence of paroxysmal atrial fibrillation after radiofrequency ablation based on clinical data and serum markers

XIONG Xiang-yu; LYU Juan; WANG Jia-qi

doi:10.3969/j.issn.1672-5301.2025.05.006

Abstract：Objective To construct a Nomogram prediction model for recurrence of paroxysmal atrial fibrillation(PAF)patients after radiofrequency ablation(RFA)based on the clinical data and serum markers.Method A total of 237 patients with PAF who underwent RFA treatment in Xiangyang Central Hospital from March 2022 to March 2023 were selected for follow-up for 12 months after discharge.The recurrence rate during the follow-up period was calculated and the patients were divided into the recurrence group and the non-recurrence group.The clinical data and serum markers[high-sensitivity C-reactive protein(hs-CRP),soluble growth-stimulating expression gene 2(sST2),brain natriuretic peptide(BNP),matrix metalloproteinase-9(MMP-9),N-acetylneuraminic acid(Neu5Ac),macrophage inflammatory protein 1α(MIP-1α)and trimethylamine oxide(TMAO)]of the two groups were compared.Lasso-Cox regression analysis was used to identify the factors affecting the recurrence of PAF patients after RFA.Based on these factors,a Nomogram prediction model for the recurrence of PAF patients after RFA was constructed.The predictive value of the model was evaluated using the receiver operating characteristic(ROC)curve and decision curve analysis.Results The recurrence rate of 230 PAF patients who completed follow-up after RFA treatment was 19.57％at 12 months.The preoperative age,disease duration,proportion of coronary heart disease,proportion of hypertension,proportion of diabetes,proportion of hyperlipidemia,LAD,LAVI,CHA2DS2-VASc score,serum hs-CRP,sST2,BNP,MMP-9,Neu5Ac,MIP-1α and TMAO levels in the recurrent group were higher than those in the non-recurrent group,while the left atrial appendage systolic peak strain rate(SSR)was lower than that in the non-recurrent group(P＜0.05).Lasso-Cox regression analysis revealed that preoperative hypertension,diabetes,hyperlipidemia,LAD,LAVI,left atrial appendage SSR,serum hs-CRP,sST2,BNP,Neu5Ac,MIP-1α and TMAO levels were all the influencing factors for recurrence after RFA in PAF patients(P＜0.05).After adjusting for age,disease duration,coronary heart disease,CHA2DS2-VASc score,serum MMP-9 level,preoperative hypertension,diabetes,hyperlipidemia,LAD,LAVI,left atrial appendage SSR,serum hs-CRP,sST2,BNP,Neu5Ac,MIP-1α and TMAO levels remained as the influencing factors for recurrence after RFA in PAF patients(P＜0.05).Based on the 12 influencing factors identified by Lasso-Cox regression analysis,a Nomogram prediction model for recurrence after RFA in PAF patients was constructed.The model's area under the curve(AUC)for predicting recurrence after RFA in PAF patients was 0.941(95％CI 0.899-0.983),with a cutoff value of 130.08 points,indicating high predictive performance and good clinical utility in predicting recurrence after RFA in PAF patients.Conclusion The Nomogram prediction model for PAF patients after RFA recurrence,constructed based on clinical data and serum markers,has high predictive power and clinical utility,and can provide reliable clinical evidence for identifying the high-risk patients.