陈忠秀, 白文娟, 唐红, 等.心脏增强断层扫描分析非瓣膜性心房颤动患者的左心耳大小及形态.四川大学学报(医学版),2017,48(6):911-916
心脏增强断层扫描分析非瓣膜性心房颤动患者的左心耳大小及形态
Assessment of Left Atrial Appendage Size and Morphology by Enhanced Cardiac Computed Tomography in Patients with Non-valvular Atrial Fibrillation
  
中文关键词:  非瓣膜性心房颤动左心耳血栓形成 心脏增强断层扫描
英文关键词:Non-valvularatrial fibrillationLeft atrial appendageThrombus formationEnhanced cardiac computed tomography scanning
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中文摘要:
      目的 通过心脏增强断层扫描(CT)分析非瓣膜性心房颤动(NVAF)患者左心耳(LAA)大小及形态,并探讨CT在NVAF患者血栓栓塞预防诊疗中的价值。 方法 前瞻性的纳入2012年12月至2014年1月拟行射频消融术治疗的NVAF患者189例,同时纳入无并发器官功能障碍的相对正常的拟行射频消融术的房性心动过速(简称房速)患者作为对照组(52例),术前行CT心脏增强扫描检查。对纳入患者进行包括基本资料、并发疾病、抗凝治疗和心房颤动(AF)持续情况在内的全面的临床评估。采用CHA2DS2-VASc评分标准评价NVAF患者血栓栓塞风险。并根据CT显像LAA有无血栓形成将NVAF患者分为血栓组(13例)和非血栓组(176例)。比较对照组和不同CHA2DS2-VASc评分血栓栓塞风险亚组以及有无LAA血栓形成亚组之间LAA大小、形态的差异,并通过logistic回归模型分析上述LAA参数对NVAF患者血栓形成风险的预测价值。 结果 与对照组比较,NVAF患者具有较大的LAA开口径,对照组风向标及仙人掌型LAA居多,而NVAF患者4种LAA形态大致相等。LAA开口及容积随着CHA2DS2-VASc评分血栓栓塞风险的增加而呈增大趋势,中低危血栓栓塞风险组鸡中翼型LAA居多,而栓塞高风险组菜花型LAA居多。与非血栓组比较,LAA血栓组NVAF患者具有较大的LAA开口、容积和较多的菜花型LAA。Logistic回归分析提示除CHA2DS2-VASc评分外,菜花型及大的LAA开口径可独立预测NVAF患者的血栓形成风险。 结论 心脏CT增强扫描能很好地分析LAA大小及形态,且相关参数对NVAF患者LAA血栓形成有一定的预测价值。
英文摘要:
      Objective This study was designed to investigate left atrial appendage (LAA) size and morphology characteristics in patients with non-valvular atrial fibrillation (NVAF) by enhanced cardiac computed tomography (CT) scanning, and to evaluate the predictive value of these parameters for thromboembolic risk. MethodsA total of 189 NVAF patients were prospectively enrolled during December 2012 to January 2014 in West China Hospital of Sichuan University. Fifty-two atrial tachycardia patients without organ dysfunction were also recruited as controls. All subjects were scheduled for radiofrequency ablation and underwent enhanced cardiac CT scan. The clinical characteristics, comorbid diseases, anticoagulant therapy, and AF chronicity were collected and CHA2DS2-VASc score was calculated for the assessment of thromboembolic risk. The NVAF cohort was also divided further into LAA thrombus present (n=13) and absent (n=176) subgroup according to LAA with thrombus or not. Differencesin size and morphology characteristics of the LAA were compared among controls and different CHA2DS2-VASc thromboembolic risk subgroups, and between LAA thrombus and non-thrombus group. In addition, logistic regression analysis was used to identify whether these parameters predict thrombus formation independent of the CHA2DS2-VASc score in NVAF patients. ResultsCompared with controls, NVAF patients had significantly bigger orifice size. Windsock and cactus-type LAA were main morphology in controls, while the distribution of the four kinds of LAA types were similar in NVAF patients. The orifice and volume of the LAA were increased with increasing CHA2DS2-VASc riskscore, and chicken wing-type LAA was the predominant prevalence in low-intermediate thromboembolic risk subgroup while cauliflower in high thromboembolic risk subgroup. Compared with non-thrombus patients, LAA-thrombussubgroup exhibited a significantly increased orifice and volume, and higher prevalenceof the cauliflower shaped LAA. Logistic regression showed that the LAA orifice and cauliflower shape were independent predictors for thrombus formation in patients with NVAF following adjustment for the CHA2DS2-VASc score. ConclusionCardiac images obtained with CTis feasible for the analysis of LAA size and morphology, and these parameters provide incremental value in assessing the LAA thrombus risk in patients with NVAF.
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