冠状动脉CTA延迟扫描对心房颤动患者左心耳封堵术前血栓评估的临床价值研究  

Delayed coronary computed tomographic angiography for thrombus assessment in patients with atrial fibrillation before left atrial appendage occlusion:a study on clinical value

作　　者：魏凯[1] 何柏[1] 王玺 穆洋[2] 张威[1] 荆晶[1] 郭军[2] 陈韬[2] Wei Kai;He Bai;Wang Xi;Mu Yang;Zhang Wei;Jing Jing;Guo Jun;Chen Tao(Department of Cardiovascular Medicine,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管内科,北京100853 [2]解放军总医院第六医学中心心血管病医学部,北京100048

出　　处：《中国循证心血管医学杂志》2023年第4期428-431,435,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家重点研发计划(2018YFC2001205)。

摘　　要：目的 探讨冠状动脉计算机断层扫描血管成像(CCTA)增强扫描联合延迟扫描,对心房颤动(房颤,AF)患者左心耳封堵术(LAAO)前左心耳(LAA)内血栓的诊断效能和有效放射剂量。方法 回顾性纳入2018年1月至2020年12月,于中国人民解放军总医院心血管内科住院拟行LAAO的非瓣膜性AF患者109例(其中阵发性AF患者48例,持续性AF患者61例)。所有患者在术前48 h接受CCTA回顾性心电门控增强扫描联合FLASH舒张期单期延迟扫描,并在术前24 h进行经食道超声心动图(TEE)检查。以TEE作为诊断“金标准”,分析CCTA的诊断效能和有效放射剂量。结果 阵发性AF与持续性AF患者一般临床资料的组间差异均无统计学意义(P>0.05)。CCTA联合扫描相较TEE表现出良好的诊断效能,具有较高的灵敏度(88.89%)、特异度(93.90%)和准确度(92.66%)。CCTA联合扫描相比增强扫描可显著提高特异度(75.61%vs. 93.90%,P=0.003),尤其在持续性AF患者中特异度改善明显(61.36%vs. 93.18%,P=0.001),而在阵发性AF患者中特异度改善不明显(92.11%vs. 94.74%,P>0.05)。此外,CCTA联合扫描并未显著增加有效放射剂量[(10.65±3.17)mSv vs.(9.87±3.12)mSv,P=0.167]。结论 AF患者在LAAO术前行CCTA增强扫描联合延迟扫描,对LAA内血栓具有较佳的诊断效能且不带来显著的有效放射剂量增加。Objective To investigate the diagnostic efficacy and effective radiation dose of enhanced coronary computed tomographic angiography(CCTA)combined with delayed CCTA for thrombus assessment in left atrial appendage(LAA)in patients with atrial fibrilation(AF)before left atrial appendage occlusion(LAAO).Methods AF(n=109)with planed LAAO were chosen from Department of Cardiovascular Medicine in Chinese PLA General Hospital from Jan.2018 to Dec.2020,including 48 patients with paroxysmal atrial fibrillation(PAF group)and 61 patients with persistent atrial fibrillation(PeAF group).All patients received retrospective enhanced CCTA gated by ECG combined with delayed scanning of FLASH diastolic single-phase scan 48 h before LAAO,and received examination of transesophageal echocardiography(TEE)24 h before LAAO.The diagnostic efficacy and effective radiation dose of CCTA were analyzed taken TEE as a gold standard of diagnosis.Results The differences in general clinical materials had no statistical significance between PAF group and PeAF group(P>0.05).Compared with TEE,the combined CCTA had an excellent diagnostic efficacy with higher sensitivity(88.89%),specificity(93.90%)and accuracy(92.66%).Compared with enhanced CCTA,the specificity was significantly promoted by combined CCTA(75.61%us.93.90%,P=0.003),and was promoted more significantly(61.36%us.93.18%,P=0.001)especially in PeAF group.The specificity was not promoted significantly in PAF group(92.11%us.94.74%,P>0.05).Furthermore,the effective radiation dose of combined CCTA was not significantly promoted[(10.65+3.17)mSv us.(9.87±3.12)mSv,P=0.167).Conclusions The enhanced CCTA combined with delayed CCTA has an excellent diagnostic efficacy on LAA thrombus without effective radiation dose increase in AF patients before LAAO.

关 键 词：心房颤动 左心耳封堵术 左心耳血栓 冠状动脉计算机断层扫描血管成像 延迟扫描 

分 类 号：R541.75[医药卫生—心血管疾病]