代谢功能障碍相关脂肪性肝病与导管消融术后心房颤动复发：一项系统评价与荟萃分析。
完整摘要 · 中文译文
背景：导管消融（CA）是心房颤动（AF）的既定节律控制策略；然而，AF复发仍然常见，并受潜在心脏代谢基质的影响，包括代谢功能障碍相关脂肪性肝病（MASLD）。本研究旨在评估MASLD及MASLD相关纤维化风险与CA后AF复发的关系。 方法：我们进行了一项系统综述和随机效应荟萃分析，纳入报告CA后AF复发、并按MASLD状态和肝纤维化风险（使用纤维化-4（FIB-4）指数和非酒精性脂肪性肝病（NAFLD）纤维化评分（NFS）评估）分层的观察性研究。符合条件的研究包括因AF接受CA的成人，报告了复发结局并按MASLD或纤维化风险类别分层。 结果：共识别160条记录，7项研究纳入定性综合。6项研究（包括2921例患者）纳入主要荟萃分析，比较MASLD与无MASLD。另一项仅针对纤维化的研究纳入纤维化分层分析。6项研究的荟萃分析（MASLD：894；非MASLD：2027）表明，MASLD与CA后AF复发风险显著升高相关（风险比（RR）1.77，95%置信区间（CI）1.43-2.18；p < 0.001；I2 = 64.1%）。在另一项纳入5项报告校正估计值研究的荟萃分析中，MASLD仍与复发显著相关（风险比（HR）2.13，95% CI 1.49-3.04；p < 0.001；I2 = 70.5%）。在f 纤维化分层分析显示，与低评分相比，中/高FIB-4（RR 2.03，95% CI 1.27-3.26；p = 0.003；I2 = 71.3%）和中/高NFS（RR 1.65，95% CI 1.12-2.43；p = 0.01；I2 = 49.9%）与更高的房颤复发风险相关。 结论：MASLD与导管消融（CA）术后房颤复发风险显著升高相关。使用FIB-4和NFS进行纤维化风险分层也显示，中/高纤维化与复发率升高之间存在显著关联。 PROSPERO注册号：CRD420261335405，https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335405。
完整摘要 · 英文原文
BACKGROUND: Catheter ablation (CA) is an established rhythm-control strategy for atrial fibrillation (AF); however, AF recurrence remains common and is influenced by the underlying cardiometabolic substrate, including metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association of MASLD and MASLD-related fibrosis risk with AF recurrence following CA. METHODS: We conducted a systematic review and random-effects meta-analysis of observational studies reporting AF recurrence after CA, stratified by MASLD status and liver fibrosis risk, as assessed using the fibrosis-4 (FIB-4) index and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS). Eligible studies included adults undergoing CA for AF with recurrence outcomes reported and stratified by MASLD or fibrosis risk categories. RESULTS: A total of 160 records were identified, and seven studies were included in the qualitative synthesis. Six studies, including 2921 patients, contributed to the primary meta-analysis comparing MASLD versus no MASLD. An additional fibrosis-only study contributed to fibrosis-stratified analyses. The meta-analysis of six studies (MASLD: 894; non-MASLD: 2027) demonstrated that MASLD was associated with a significantly higher risk of AF recurrence after CA (risk ratio (RR) 1.77, 95% confidence interval (CI) 1.43-2.18; p < 0.001; I2 = 64.1%). In a separate meta-analysis of five studies reporting adjusted estimates, MASLD remained significantly associated with recurrence (hazard ratio (HR) 2.13, 95% CI 1.49-3.04; p < 0.001; I2 = 70.5%). In fibrosis-stratified analyses, Intermediate/High FIB-4 (RR 2.03, 95% CI 1.27-3.26; p = 0.003; I2 = 71.3%) and Intermediate/High NFS (RR 1.65, 95% CI 1.12-2.43; p = 0.01; I2 = 49.9%) were associated with a higher risk of AF recurrence compared with low scores. CONCLUSION: MASLD is associated with a significantly higher risk of AF recurrence after CA. Fibrosis risk stratification using FIB-4 and NFS also shows a significant association between Intermediate/High fibrosis and increased recurrence rates. PROSPERO REGISTRATION: CRD420261335405, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335405.