两种不同的左心耳形态分型方法与非瓣膜性心房颤动患者左心耳血栓形成和/或自发超声显影的关系  

The relationship between two different left atrial appendage morphological classification systems and left atrial appendage thrombosis/spontaneous echocardiographic contrast in patients with nonvalvular atrial fibrillation

作　　者：刘眷璋 余太慧[1] 谭朝迪 郑钰萍 吴涛[1] 耿登峰[1] 周淑娴[1] LIU Juan-zhang;YU Tai-hui;TAN Chao-di;ZHENG Yu-ping;WU Tao;GENG Deng-feng;ZHOU Shu-xian(Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,Guangdong,China)

机构地区：[1]中山大学孙逸仙纪念医院心内科,广东广州510120

出　　处：《中国心脏起搏与心电生理杂志》2022年第4期297-302,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金(81870294);广东省科技计划项目(2017A020215175)。

摘　　要：目的探究两种不同的左心耳(LAA)形态分型方法与非瓣膜性房颤患者LAA血栓形成和/或自发超声显影(LAAT/SEC)的关系,并比较两种LAA分型方法的异同。方法连续纳入2011年1月至2020年5月在中山大学孙逸仙纪念医院确诊为非瓣膜性房颤拟行射频消融治疗的住院患者485例,年龄为(61.4±10.1)岁,女性占比38.8%。所有患者入院前无常规抗凝治疗,射频消融术前均行经食管心脏超声和肺静脉CT检查。将所有患者根据经食管心脏超声检查结果分为LAAT/SEC组(78例,16.1%)及非LAAT/SEC组(407例,83.9%)。收集所有患者的临床资料及传统LAA分型、LAA-L/H分型等LAA相关指标。比较两种LAA分型的关系及其与LAAT/SEC的关系。结果在485例患者中,LAA-L/H分型分为LAA-L型55例(11.3%)和LAA-H型430例(88.7%);传统LAA分型分为鸡翅型157例(32.4%)、风向标型88例(18.1%)、仙人掌型57例(11.8%)、菜花型183例(37.7%)。非LAAT/SEC组鸡翅型(149例,36.6%)较LAAT/SEC组(8例,10.3%)增多(P<0.001),非LAAT/SEC组LAA-L(54例,13.3%)较LAAT/SEC组(1例,1.3%)增多(P=0.002)。LAA-L的表观均为鸡翅型55例(100%);LAA-H的表观分布为鸡翅型102例(23.7%),风向标型88例(20.4%)、仙人掌型57例(13.3%)、菜花型183例(42.6%)。多因素Logistic回归分析表明,LAA-L(OR=0.126,95%CI 0.016~0.974,P=0.047)和鸡翅型LAA(OR=0.296,95%CI 0.129~0.679,P=0.004)均是LAAT/SEC的保护因素。结论LAA-L/H分型和传统LAA分型均与LAAT/SEC相关。LAA-L是鸡翅型LAA的子集,LAA-L和鸡翅型LAA均具有更低的LAAT/SEC发生风险。Objective To explore the relationship between the two different left atrial appendage(LAA)morphological classification systems and left atrial appendage thrombosis/spontaneous echocardiographic contrast(LAAT/SEC)in patients with non-valvular atrial fibrillation(NVAF),and to compare the similarities and differences between the two LAA classification systems.Methods We included 485 consecutive inpatients who were diagnosed with NVAF and planned to undergo radiofrequency ablation at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2011 to May 2020.The age of the patients was(61.4±10.1)years old,and the proportion of females was 38.8%.All patients had no previous anticoagulation treatment before admission.Before radiofrequency ablation,all patients underwent transesophageal echocardiography and pulmonary vein computed tomography.According to whether the LAAT/SEC was present or not,the patients were divided into LAAT/SEC group(78,16.1%)or non-LAAT/SEC group(407,83.9%).Patients′clinical data,the traditional LAA morphologies,LAA-L/H morphologies and the other LAA anatomical characters were collected.The relationship between the two different LAA morphological classification systems and its relationship with LAAT/SEC were compared,ResultsAmong the 485 patients,the distribution of LAA-L/H morphologies was LAA-L(55,11.3%)and LAA-H(430,88.7%).And the distribution of traditional LAA morphologies was chicken-wing type(157,32.4%),windsock type(88,18.1%),cactus type(57,11.8%)and cauliflower type(183,37.7%).Compared with the LAAT/SEC group,the proportion of LAA-L[54(13.3%)vs 1(1.3%),P=0.002]and chicken-wing type[149(36.6%)vs 8(10.3%),P<0.001J was higher in non-LAAT/SEC group.All LAA-L were classified as chickenwing type(55,100%)and LAA-H was classified as chicken-wing type(102,23.7%),windsock type(88,20.4%),cactus type(57,13.3%)and cauliflower type(183,42.6%).Multivariate logistic regression analysis showed that LAA-L(OR=0.126,95%CI 0.016-0.974,P=0.047)and chicken-wing type LAA(OR=0.296,95%CI 0.129-0.679,P

关 键 词：心血管病学 左心耳形态 非瓣膜性房颤 血栓形成 自发超声显影 

分 类 号：R541.75[医药卫生—心血管疾病] R543.31[医药卫生—内科学] R540.45[医药卫生—临床医学]