心房颤动患者选择性左心耳造影与食管超声测量左心耳的一致性研究  

Consistency of selective angiography and transesophageal echocardiography in measure left atrial appendage in patients with atrial fibrillation

作　　者：孔彬[1] 刘育[1] 廖佳芬[1] 杨新红[1] 周青[2] 宋宏宁[2] 黄鹤[1] 

机构地区：[1]武汉大学人民医院心内科武汉大学心血管病研究所心血管病湖北重点实验室,430060 [2]武汉大学人民医院超声科

出　　处：《中华心律失常学杂志》2016年第1期49-52,76,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的本研究旨在探索选择性左心耳造影与经食管心脏超声（transesophageal echocardio—graphy，TEE）对心房颤动（房颤）患者左心耳口部直径和深度测量结果的一致性。为未来左心耳封堵术提供最优化治疗方案。方法入选2014年4月至8月在武汉大学人民医院拟行射频消融术的房颤患者，所有患者均在术前行TEE和术中行选择性左心耳造影测量左心耳口部直径和深度。采用配对t检验、Pearson相关分析和Bland．Altman分析评价两种测量方法的相关性及一致性。结果共入选43例行房颤射频消融术的患者，男，21例（48．80％），平均年龄（69．20±8．30）岁。配对t检验显示：术中选择性左心耳造影与术前TEE测得左心耳口部直径[（24．13±4．45）mill对（23．37±4．60）mm，P=0．060]和深度[（25．76±6．47）mm对（26．47±6．78）mm，p_-0．212]，差异无统计学意义。Pearson相关分析显示：两种方法测量左心耳口部直径和深度均呈正相关（r=0．905，0．906，均P〈0．001）。Bland—Ahman评价显示：两种方法测量左心耳口部直径的一致性界限范围为（-2．90mm，4．86mm），深度的一致性界限范围为（一6．57mm，4．73mm），其中均有4．65％（2／43）的点在95％的一致性界限范围外。在一致性界限范围内，左心耳口部直径和深度差值的绝对值最大分别为4．20mm、5mm，一致性较好。结论选择性左心耳造影与术前TEE对左心耳口部直径和深度测量一致性较好，在有经验的中心可仅用选择性左心耳造影来指导未来房颤患者的左心耳封堵术。Objective This study aimed to explore consistency of angiography and transesophageal echocardiography（TEE） in measure left atrial appendage （LAA） orifice diameter and depth in patients with at- rial fibrillation（AF） , and to provide the best treatment options for future LAA closure. Methods Selected AF patients who underwent radiofrequency ablation, all patients went through preoperative TEE and intraoperative selective angiography to measure LAA orifice diameter and depth. Paired t-test,Pearson correlation analysis and Bland-Altman analysis were used to evaluate the relevance and consistency of the two measurement methods. Results Forty three patients were enrolled, and the average age was （69.2 ± 8.3 ） years, male was 21 （48.8%）. Paired t test demonstrated that it did not significantly differ between intraoperative angiography and preoperative TEE in measure LAA orifice diameter[ （24. 13±4.45） mm vs.（23.37±4. 60） mm,P=0. 060）] and depth [ （ 25.76 ± 6.47 ） mm vs. （ 26. 47 ± 6. 78） mm, P = 0. 212） ]. Pearson correlation analysis showed that the two ways to measure the LAA orifice diameter and depth were positively correlated （ r = 0. 905,0. 906, all P〈0. 001 ）. Bland-Ahman method showed that the two methods for measuring consistency range limits of LAA orifice diameter were （ -2. 90 ram,4. 86 ram） and depth were （ -6. 57 ram,4. 73 ram） ,of which were 4. 65% （2/43） points outside the range of 95% limits of agreement. Within the range limits of consistency, the maximum absolute value of difference about LAA orifice diameter and depth were 4. 2 mm,5 mm,which had a good consistency. Conclusion There was a high consistency between selective angiography and TEE in measure LAA orifice diameter and depth in patients with AF. The sel^tive angiography of LAA can be used to guide the LAA closure in AF patients in experienced centers in the future.

关 键 词：心房颤动 选择性造影 经食管心脏超声 左心耳 一致性 

分 类 号：R541.75[医药卫生—心血管疾病]