基于冠状动脉CT血管成像的左心耳测量参数对非瓣膜性心房颤动患者心源性脑卒中的预测价值  

Value of left atrial appendage measurement parameters based on coronary CT angiography in predicting cardiogenic stroke in patients with nonvalvular atrial fibrillation

作　　者：王润榕 胡春洪[2] 王苇[1] 李郑[1] 张帅 李伟 侯红玲 Wang Runrong;Hu Chunhong;Wang Wei;Li Zheng;Zhang Shuai;Li Wei;Hou Hongling(Medical Imaging Center,the Affiliated Hospital of Yangzhou University,Yangzhou 225000,China;Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Neurology,the Affiliated Hospital of Yangzhou University,Yangzhou 225000,China;Department of Cardiology,the Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院医学影像中心,225000 [2]苏州大学附属第一医院放射科,215000 [3]扬州大学附属医院神经内科,225000 [4]扬州大学附属医院心脏内科,扬州225000

出　　处：《中华放射学杂志》2021年第7期751-757,共7页Chinese Journal of Radiology

基　　金：国家重点研发计划(2017YFC0114300);苏州市姑苏卫生人才计划项目(GSWS2020003)。

摘　　要：目的探讨冠状动脉CTA(CCTA)左心耳测量参数对非瓣膜性房颤(NVAF)患者心源性脑卒中(CS)发病风险的预测价值。方法前瞻性收集2014年1月至2017年6月179例行CCTA检查的NVAF患者的临床和检查资料。根据CCTA检查后2年内急性缺血性脑卒中和短暂性脑缺血发作(TIA)的发病情况进行分组,其中符合CS标准的为病例组(87例),无急性缺血性脑卒中且无TIA发作的患者为对照组(92例)。使用心功能分析软件测量左心耳的开口长短径和面积、深度、容积参数,用体表面积校正各测量值,获得该参数的校正指数,进行数据处理。采用独立样本t检验、Mann-Whitney U检验及χ^(2)检验比较两组各项指标的差异,采用二元logistic回归分析体质指数、高血脂、房颤病史年数、左心耳开口面积指数(LAAOA Index)、左心耳射血分数(LAAEF)对CS发病的影响。通过ROC曲线评估LAAOA Index和LAAEF对CS发病的预测价值。结果病例组左心耳开口长短径和面积、最大和最小容积的校正指数以及LAAEF分别为(1.80±0.21)cm/m^(2)、(1.19±0.17)cm/m^(2)、(3.20±0.71)cm^(2)/m^(2)、(7.91±1.92)ml/m^(2)、(5.03±1.40)ml/m^(2)、(36.20±10.54)%,对照组分别为(1.64±0.24)cm/m^(2)、(1.06±0.19)cm/m^(2)、(2.65±0.64)cm^(2)/m^(2)、(6.61±1.68)ml/m^(2)、(3.67±1.28)ml/m^(2)、(45.25±10.07)%,差异均有统计学意义(t值分别为4.783、4.647、5.481、4.826、6.823、-5.875,P值均<0.001)。二元logistic回归分析显示LAAOA Index增大(P=0.005)和LAAEF减小(P<0.001)是NVAF患者发生CS的独立危险因素。LAAOA Index的ROC曲线下面积(AUC)为0.712(95%CI 0.639~0.777),最佳诊断界值为3.16 cm^(2)/m^(2);LAAEF的AUC值为0.734(95%CI 0.663~0.797),界值为38.71%;LAAOA Index联合LAAEF的AUC值为0.786(95%CI 0.718~0.843)。结论CCTA检查可以利用冠状动脉血管扫描数据,对左心耳大小和功能进行一站式、比较准确的评价。CCTA左心耳测量参数可以作为CHA2DS2-VASc评分的补充,为NVAF患者CS�Objective To investigate the predictive value of measurement parameters of left atrial appendage by coronary CTA(CCTA)for the risk of cardiogenic stroke(CS)in patients with nonvalvular atrial fibrillation(NVAF).Methods The clinical and examination data of 179 patients with NVAF who underwent CCTA examination were retrospectively analyzed.The selected patients were grouped according to the outbreak of acute ischemic stroke and TIA within 2 years after CCTA examination.Patients who met the criteria for CS were selected as cases(87 patients),and those with neither stroke nor TIA as controls(92 patients).The diameter and area of left atrial appendage(LAA)orifice,the LAA depth,and the LAA volume were measured by using dedicated software.The parameter was corrected using the body surface area(BSA)to obtain the correction index of corresponding parameter.The independent samples t test,Mann-Whitney U test,and Chi-square test were used to compare the differences in various indicators between the two groups.Binary logistic regression was used to analyze the impacts of body mass index(BMI),hyperlipidemia,the duration years of atrial fibrillation,left atrial appendage area index(LAAOA Index),and the left atrial appendage emptying fraction(LAAEF)on the risk of CS.The ROC curve was used to evaluate the predictive value of LAAOA Index and LAAEF for the onset of CS.Results The correction index of the left atrial appendage orifice maximum and minimum diameter,the left atrial appendage orifice area,and the maximum&minimum left atrial appendage volume and the LAAEF in the case group were(1.80±0.21)cm/m^(2),(1.19±0.17)cm/m^(2),(3.20±0.71)cm^(2)/m^(2),(7.91±1.92)ml/m^(2),(5.03±1.40)ml/m^(2),(36.20±10.54)%,and those value in the control group were(1.64±0.24)cm/m^(2),(1.06±0.19)cm/m^(2),(2.65±0.64)cm^(2)/m^(2),(6.61±1.68)ml/m^(2),(3.67±1.28)ml/m^(2),(45.25±10.07)%,the differences were statistically significant(t=4.783,4.647,5.481,4.826,6.823,and-5.875,all P<0.001).Binary logistic regression analysis showed that the increase

关 键 词：心房颤动 左心耳 体层摄影术 X线计算机 心源性脑卒中 

分 类 号：R541.75[医药卫生—心血管疾病] R816.2[医药卫生—内科学] R743.3[医药卫生—临床医学]