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

发布时间：2018-05-14 17:21

本文选题：非瓣膜性心房颤动 + 左心耳　；参考：《四川大学学报(医学版)》2017年06期

【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。
[Abstract]:Objective to analyze the size and shape of left atrial auricle (LAA) in patients with non-valvular atrial fibrillation (NVAF) by enhanced computed tomography (CT), and to explore the value of CT in the diagnosis and treatment of thromboembolism in patients with NVAF. Methods from December 2012 to January 2014, 189 patients with NVAF underwent radiofrequency ablation. At the same time, 52 patients with atrial tachycardia (atrial tachycardia) who were not complicated with organ dysfunction were included as control group. A comprehensive clinical evaluation including basic data, complications, anticoagulant therapy, and atrial fibrillation (AF) persistence was performed. The risk of thromboembolism in patients with NVAF was evaluated by CHA2DS2-VASc score. The patients with NVAF were divided into thrombus group (n = 13) and non-thrombus group (n = 176). The size and morphology of LAA were compared between the control group, the subgroup with different CHA2DS2-VASc score and the subgroup with or without LAA thromboembolism, and the predictive value of the above LAA parameters to the thrombotic risk of NVAF patients was analyzed by logistic regression model. Results compared with the control group, the patients with LAA had larger open caliber of LAA. In the control group, most of them were wind vane and cactus type LAA. However, the opening and volume of LAA in NVAF patients were approximately the same. The opening and volume of LAA increased with the increase of the risk of thromboembolism in CHA2DS2-VASc score. In middle and low risk group, most of them were LAA with airfoil, while those with high risk of embolization were mostly LAA of cauliflower. Compared with the non-thrombus group, the patients with NVAF had larger LAA openings, volume and more vegetable pattern LAA.Logistic regression analysis showed that, besides CHA2DS2-VASc score, cauliflower type and large LAA opening caliber could independently predict the risk of thrombosis in NVAF patients. Conclusion enhanced cardiac CT scan can analyze the size and morphology of LAA, and the relevant parameters can predict LAA thrombosis in NVAF patients.
【作者单位】：四川大学华西医院心内科;四川大学华西医院放射科;
【基金】：四川省科技厅科技支撑计划项目(No.2014SZ0004-8)资助
【分类号】：R541.75

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