心脏CT血管成像在左心耳封堵术后评估新内皮化的应用价值  

Application value of cardiac CT angiography in evaluating neoendothelialization after left atrial appendage occlusion

作　　者：刘从彬[1] 张继[1] 李瑗[1] LIU Congbin;ZHANG Ji;LI Yuan(Department of Radiology,Taizhou People's Hospital,Taizhou 225300,China)

机构地区：[1]泰州市人民医院医学影像科,225300

出　　处：《心肺血管病杂志》2021年第10期1058-1062,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨双源CT双能量心脏CT血管成像对左心耳封堵(LAAC)术后评估封堵器新内皮化的应用价值。方法:收集接受LAAC术后6个月行心脏CT血管成像的患者,采用标准化多曲面重建评估封堵器周围残余分流、对比剂残留情况,无对比剂残留定义为完全新内皮化,无周围残余分流但存在对比剂残留定义为不完全新内皮化,存在周围残余分流定义为不完全内皮化。分析可能影响内皮生长的潜在预测因素包括糖尿病、BMI、年龄、封堵器大小和设备类型与内皮化的关系。结果:53例患者接受LAAC并在6个月后180(178,180)d行心脏CT血管成像进行评估,其中36例(68%)无封堵器周围残余分流。36例患者中,16例(44%)左心耳内无对比剂残留且中期随访显示完全新内皮化,20例(56%)出现左心耳内对比剂残余,提示不完全新内皮化。在完全和不完全新内皮化患者中,封堵装置类型(P=0.739)和大小(P=1.000),差异无统计学意义,完全和不完全新内皮化患者的左心耳形态,差异无统计学意义(P=0.152)。另外,年龄、BMI、糖尿病及肝脏疾病与完全新内皮化无显著相关性。结论:LAAC术后6个月的中期随访中,大多数患者的新内皮化仍不完全,需要进一步研究不完全新内皮化的原因,以指导临床治疗计划。Objective:Objective to investigate the application value of dual source CT dual energy cardiac CT imaging in evaluating new endothelialization of occluder after left atrial appendage occlusion.Methods:The patients who underwent cardiac CT imaging 6 months after left atrial appendage occlusion were collected.The residual shunt and residual contrast agent around the occluder were evaluated by standardized multi curved surface reconstruction.No residual contrast agent was defined as complete new endothelialization,no residual shunt but residual contrast agent was defined as incomplete new endothelialization,and residual shunt was defined as incomplete endothelialization.Potential predictors of endothelial growth including diabetes,body mass index,age,occluder size and device type were analyzed.Results:53 patients underwent LAAC and underwent cardiac CT imaging 6 months later,median 180(178,180)days.Among them,36 patients(68%)had no residual shunt around the occluder.Of the 36 patients,16(44%)had no residual contrast agent in the left atrial appendage and showed complete neoendothelialization in mid-term follow-up,while 20(56%)had residual contrast agent in the left atrial appendage,indicating incomplete neoendothelialization.There was no significant difference in the type(P=0.739)and size(P=1.000)of occluder device between complete and incomplete neoendothelialization patients.There was no significant difference in the morphology of left atrial appendage between complete and incomplete neoendothelialization patients(P=0.152).In addition,age,body mass index,diabetes and liver disease had no significant correlation with complete neoendothelialization.Conclusions:In the mid-term follow-up of 6 months after left atrial appendage occlusion,the neoendothelialization of most patients is still incomplete,so it is necessary to further study the causes of incomplete neoendothelialization in order to guide the clinical treatment plan.

关 键 词：左心耳封堵术 心房颤动 心脏CT血管成像 新内皮化 

分 类 号：R54[医药卫生—心血管疾病]