经食道超声心动图与计算机断层显像造影检查在左心耳封堵器型号选择中应用价值  

The value of transesophageal echocardiography and computer tomography angiography in selection of the size of left atrial appendage occluder

作　　者：傅明 梁明 孙鸣宇 金志清 丁建 张萍 王祖禄 FU Ming;LIANG Ming;SUN Ming-yu;JIN Zhi-qing;DING Jian;ZHANG Ping;WANG Zu-lu(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Graduate School,Dalian Medical University,Dalian 116051,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016 [2]大连医科大学研究生院,辽宁大连116051

出　　处：《临床军医杂志》2024年第2期125-129,共5页Clinical Journal of Medical Officers

基　　金：辽宁省应用基础研究计划(2022JH2/101500017);沈阳市关键技术攻关计划(21-172-9-11)。

摘　　要：目的探讨计算机断层显像造影(CTA)、经食道超声心动图(TEE)两种影像学方法在左心耳封堵术前封堵器型号选择中的应用价值。方法回顾性分析自2020年1月至2021年12月于北部战区总医院行术前CTA、TEE检查,术中完成左心耳造影(LAA-A)检查,并使用Watchman封堵器或LAmbre封堵器行左心耳封堵术的215例非瓣膜性心房颤动患者的临床资料。以LAA-A测量值为金标准,采用组内相关系数(ICC)检验CTA、TEE与LAA-A对左心耳尺寸测量结果的一致性。结果Watchman封堵器组:TEE与LAA-A测量左心耳着陆区直径ICC值为0.862(P<0.001),一致性较高;CTA与LAA-A测量左心耳着陆区直径ICC值为0.955(P<0.001),一致性较高;TEE与LAA-A测量左心耳可用深度ICC值为0.363(P<0.001),一致性较差;CTA与LAA-A测量左心耳可用深度ICC值为0.377(P<0.001),一致性较差。LAmbre封堵器组:TEE与LAA-A测量左心耳封闭线直径ICC值为0.801(P<0.001),一致性较高;CTA与LAA-A测量左心耳封闭线直径ICC值为0.965(P<0.001),一致性较高;TEE与LAA-A测量左心耳锚定区直径ICC值为0.792(P<0.001),一致性较高;CTA与LAA-A测量左心耳锚定区直径ICC值为0.934(P<0.001),一致性较高。结论在Watchman封堵器中,TEE、CTA与LAA-A所测量着陆区直径具有较好的一致性,但两种影像学方法对左心耳深度测量与LAA-A测量值一致性较差;LAmbre封堵器中,TEE、CTA与LAA-A测量的口部直径及着陆区直径一致性均较好,可用于指导封堵器型号的选择。Objective To investigate the application value of computed tomography angiography(CTA)and transesophageal echocardiography(TEE)in the selection of occluder models before left atrial appendage occluder.Methods The clinical data of 215 patients with nonvalvular atrial fibrillation who underwent preoperative CTA and TEE examination,intraoperative left atrial appendage angiography(LAA-A)examination,and left auricular occlusion with Watchman occlusive device or LAmbre occlusive device from January 2020 to December 2021 in General Hospital of Northern Theater Command were retrospectively analyzed.The gold standard for assessing LAA size was the LAA-A during the procedure.The intraclass correlation coefficient(ICC)analysis was utilized to examine the consistency of CTA,TEE,and LAA-A in measuring left atrial appendage size.Results In the Watchman group,the diameter of LAA landing zone measured by TEE was consistent with that measured by LAA-A,and the ICC value was 0.862(P<0.001).The diameter of LAA landing zone measured by CTA was consistent with that measured by LAA-A,and the ICC value was 0.955(P<0.001).However,the diameter of LAA depth zone measured by TEE was not consistent with that measured by LAA-A,the ICC value was 0.363(P<0.001).The diameter of LAA depth zone measured by CTA was not consistent with that measured by LAA-A,the ICC value was 0.377(P<0.001).In the LAmbre device,the diameter of LAA orifice measured by TEE was consistent with that measured by LAA-A,and the ICC value was 0.801(P<0.001).The diameter of LAA orifice measured by CTA was consistent with that measured by LAA-A,and the ICC value was 0.965(P<0.001).The diameter of the landing zone measured by TEE was also consistent with that measured by LAA-A,and the ICC value was 0.792(P<0.001).The diameter of the landing zone measured by CTA was consistent with that measured by LAA-A,and the ICC value was 0.934(P<0.001).Conclusion In the Watchman occluded device,TEE,CTA and LAA-A had good consistency in the diameter of the landing zone,but the left atrial a

关 键 词：计算机断层显像造影 经食道超声心动图 左心耳造影 左心耳封堵术 

分 类 号：R654.2[医药卫生—外科学]