MSCT与食管超声在不同类型房颤患者左心耳密度比与排空流速的相关性分析  

Correlation between left atrial appendage density ratio and flow velocity in patients with different types of atrial fibril⁃lation by MSCT and TEE

作　　者：付蓉 李彩英[1] 焦阳 孟媛媛 陈怡橙 倪吉琼 郑同同 FU Rong;LI Caiying;JIAO Yang;MENG Yuanyuan;CHEN Yicheng;NI Jiqiong;ZHENG Tongtong(Department of Medical Imaging,The second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院影像科,河北石家庄050000

出　　处：《医学影像学杂志》2024年第10期25-29,共5页Journal of Medical Imaging

基　　金：河北省自然科学基金项目(编号:H2019206288)。

摘　　要：目的 探讨采用256层螺旋CT(MSCT)测量不同类型房颤患者左心耳尖端与升主动脉CT值比值(LAAD-AA),观察密度比与经食管超声(transesophageal ultrasound, TEE)测量的左心耳排空流速(LAAEV)的相关性,并分析其临床意义。方法 选取152例在两周内完成心脏血管造影(CTA)和TEE检查的非瓣膜性房颤(AF)患者,其中持续性房颤(persistent atrial fibrillation,PeAF)46例(持续性组)、阵发性房颤(paroxysmal atrial fibrillation,PAF)106例(阵发性组)。采用心功能后处理软件,对AF患者的左心房最大容积(LAVmax)、左心耳开口面积、左心耳深度及密度比值进行定量测量,应用TEE记录是否存在左心耳血栓及红细胞自显影(SEC),并测量LAAEV。结果 持续性组伴心衰患者比例、左心耳SEC数量、心率、LAVmax、左心耳开口面积高于阵发性组,差异有统计学意义(P<0.05)。持续性组LAAEV、LAAD-AA小于阵发性组,差异有统计学意义(P<0.05)。左心耳深度两组间差异无统计学意义(P>0.05)。AF类型(P=0.011)、左心耳开口面积(P=0.005)和LAAD-AA(P<0.001)均是影响LAAEV的主要因素。持续性组与阵发性组LAAEV与LAAD-AA均显著相关,差异有统计学意义(r分别为0.704、0.585,P<0.001),持续性组LAAEV≤25cm/s时LAAD-AA临界值为0.410,敏感度为100%,特异度为74.1%;阵发性组LAAEV≤25cm/s时LAAD-AA临界值为0.411,敏感度为100%,特异度为92.6%。结论 不同类型AF患者左心耳密度比值与排空流速的相关性不同,这对预测AF患者卒中的风险有较高的临床价值。Objective To measure CT ratio of distal sites of the left atrial appendage to ascending aortic artery(LAAD-AA)in patients with different types of atrial fibrillation by 256-slice spiral CT,to observe the correlation between density ratio and left atrial appendage emptying velocity(LAAEV)measured by transesophageal ultrasound(TEE),and to explore its clinical significance.Methods 152 patients with atrial fibrillation who had been completed cardiac CT angiography and TEE within 14 days were collected,including 46 patients with persistent atrial fibrillation(PeAF)and 106 patients with paroxysmal atrial fibrillation(PAF).The maximum volume of left atrium(LAVmax),the opening area of left atrial appendage,the depth and density ratio of left atrial appendage were measured quantitatively by cardiac function post-processing software.The presence of left atrial appendage thrombus and spontaneous echo contrast(SEC),as well as LAAEV were measured by TEE.Results The proportion of patients with heart failure,the number of SEC,heart rate,LAVmax and the area of left atrial appendage orifice in PeAF group were higher than those in PAF group(P<0.05).LAAEV and LAAD-AA in PeAF group were lower than those in PAF group(P<0.05).LAAD-AA was smaller in the PeAF than that in the PAF group(P<0.05).The depth of left atrial appendage was not seen the difference in the two groups(P>0.05).Atrial fibrillation(P=0.011),the area of left atrial appendage orifice(P=0.005)and LAAD-AA(P<0.001)were the main factors affecting LAAEV.LAAEV and LAAD-AA were significantly correlated both in PeAF group and PAF group(r=0.704 and 0.585,P<0.001).The critical value of LAAD-AA was 0.410.When LAAEV≤25cm/s in PeAF group,the sensitivity was 100%and specificity was 74.1%.When LAAEV≤25cm/s in PAF group,the sensitivity was 100%and specificity was 92.6%.Conclusion The correlation between left atrial appendage density ratio and flow velocity is different in different types of atrial fibrillation,which is of great clinical value in predicting stroke risk in patients w

关 键 词：心房颤动 心耳 超声检查 体层摄影术 X线计算机 

分 类 号：R541.7[医药卫生—心血管疾病] R814.42[医药卫生—内科学]