基于CCTA研究房颤患者行胸腔镜下LAAL术后左心耳形态与残余分流的相关性  

The correlation between left atrial appendage morphology and peri-device leak after thoracoscopic LAAL in patients with atrial fibrillation based on CCTA

作　　者：程相宜 黄成锋 熊雨美 陆华 廖胜杰 张晓慎 王昊 沈思[1] CHENG Xiangyi;HUANG Chengfeng;XIONG Yumei;LU Hua;LIAO Shengjie;ZHANG Xiaoshen;WANG Hao;SHEN Si(Department of Medical Imaging,the First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong,China;Department of Emergency,Guangzhou Medical University Affiliated Women and Children's Medical Center,Guangzhou 510180,Guangdong,China)

机构地区：[1]暨南大学附属第一医院医学影像科心血管外科,广东广州510630 [2]广州医科大学附属妇女儿童医疗中心急诊科,广东广州510180

出　　处：《暨南大学学报（自然科学与医学版）》2024年第2期132-139,共8页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广州市科技计划项目(2023A03J1040);广州市卫健委西医类一般引导项目(20211A010027)。

摘　　要：目的:基于术后心脏CT血管成像(CCTA)技术,分析房颤(AF)患者行胸腔镜下左心耳缝扎术(LAAL)后残余分流(PDL)与左心耳(LAA)形态的关系。方法:选择暨南大学附属第一医院2017年11月至2023年4月间成功实施LAAL的AF患者62例,收集其临床资料,评估其术后CCTA图像并分析LAA形态学指标。根据LAAL术后复查结果将患者分为有PDL组(n=34)及无PDL组(n=28)。对两组患者之间具有统计学差异的各项指标进行Logistic回归分析,寻找危险因素。结果:将LAA各项参数指标纳入单因素Logistic回归进行分析,结果显示LAA短径(OR=0.393,95%CI:0.167~0.926,P=0.033)、LAA口长径(OR=0.330,95%CI:0.138~0.785,P=0.012)、LAA口短径(OR=0.083,95%CI:0.019~0.367,P=0.001)、LAA口周长(OR=0.078,95%CI:0.510~0.983,P=0.039)、LAA口面积(OR=0.499,95%CI:0.319~0.783,P=0.002)及LAA体积(OR=0.855,95%CI:0.768~0.953,P=0.005)均与术后PDL的发生相关。经多因素Logistic回归校正后,LAA口短径更长为PDL发生的独立危险因素。结论:经CCTA行LAA形态学评估对AF患者LAAL术后PDL的发生具有一定的预测价值,当LAA口短径较长时,需警惕PDL的发生。Objective:To analyze the correlation between peri-device leak(PDL)after thoracoscopic left atrial appendage ligation(LAAL)in patients with atrial fibrillation(AF)and left atrial appendage(LAA)morphology based on postoperative cardiac computed tomography angiography(CCTA).Methods:Sixty-two patients with AF who underwent successful LAAL at the First Affiliated Hospital of Jinan University from November 2017 to April 2023 were enrolled,as well as their clinical data.Their postoperative CCTA images were evaluated to assess LAA morphological parameter.Based on the follow-up results after LAAL,the patients were divided into two groups,the PDL group(n=34)and the non-PDL group(n=28).Logistic regression analysis was performed to identify significant risk factors among the variables with statistical differences between the two groups.Results:The parameters of the LAA between two groups were included in the single factor logistic regression analysis.The results showed that the short diameter of LAA(OR=0.393,95%CI:0.167~0.926,P=0.033),the long diameter of LAAO(OR=0.330,95%CI:0.138~0.785,P=0.012),the short diameter of LAAO(OR=0.083,95%CI:0.019~0.367,P=0.001),the perimeter of LAAO(OR=0.078,95%CI:0.510~0.983,P=0.039),the area of LAAO(OR=0.499,95%CI:0.319~0.783,P=0.002),and the volume of LAA(OR=0.855,95%CI:0.768~0.953,P=0.005)were associated with the occurrence of PDL.After multivariate logistic regression correction,that LAAO short diameter becomes longer was a risk factor for the occurence of PDL.Conclusion:The assessment of LAA morphology through CCTA has a certain predictive value for the occurrence of postoperative PDL in AF patients.When the short diameter of LAAO becomes longer,we need to be alert to the occurrence of PDL.

关 键 词：心脏CT血管成像(CCTA) 胸腔镜 左心耳缝扎术(LAAL) 残余分流(PDL) 房颤(AF) 

分 类 号：R541.75[医药卫生—心血管疾病]