经食管超声联合CT血管造影评价非瓣膜性心房颤动患者左心耳结构与血流动力学及左心耳血栓形成的关系  

Relationship among left atrial appendage structure,hemodynamics and left atrial appendage thrombosis reviewed by computed tomography angiography in patients with non-valvular atrial fibrillation

作　　者：李璇 胡澎涛 刘俊兰 Li Xuan;Hu Pengtao;Liu Junlan(First Department of Ultrasound Diagnosis,Central Hospital of Tangshan City,Tangshan 063000,China;不详)

机构地区：[1]唐山中心医院超声诊断一科,唐山063000 [2]唐山市玉田县医院影像科,唐山063000 [3]唐山中心医院心脏超声诊断一科,唐山063000

出　　处：《中国循证心血管医学杂志》2024年第10期1217-1221,1226,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省医学科学研究课题(20210896)。

摘　　要：目的探究经食管超声联合CT血管造影(computed tomographic angiography,CTA)评价非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者左心耳结构与血流动力学及左心耳血栓形成的关系。方法选取2020年1月至2021年12月于唐山中心医院治疗的180例NVAF患者作为研究对象,均行CTA检测和经食道超声心动图(Trans Esophageal Echocardiography,TEE),以TEE检测结果为金标准,采用Kappa检验,评估其一致性。根据患者是否有血栓形成,将其分为血栓形成组(n=36)和无血栓形成组(n=144),收集所有患者临床资料。多因素Logistics回归分析左心耳参数与血流动力学的关系以及与血栓形成的关系。应用样条函数与logistic回归相结合的限制性立方样条法估计左心耳参数与和发生血栓风险的剂量-反应关系。结果TEE共检出左心耳血栓36例(20.00%),以该结果为标准,CTA检出左心耳血栓33例,检出率为91.67%,漏诊率为13.89%,误诊率为1.39%,两者诊断结果具有高度一致性(Kappa=0.836)。无血栓形成组患者心力衰竭人数少于血栓形成组,N末端脑钠肽前体(NT-proBNP)水平、CHA2DS2-VASc评分、D-二聚体水平、血清尿酸水平均低于血栓形成组,两组间差异具有统计学意义(P<0.05)。血栓形成组左心耳开口短径、开口长径、开口面积、左心耳容积、左心房容积、左上肺静脉口长径、左心室舒张末期内径(LVEDd)和左心房内径(LAD)均大于无血栓形成组,左心室射血分数(LVEF)、左心耳血流速度(LAAV)小于无血栓形成组,两组间差异具有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,左心耳开口短径、开口长径、开口面积、左心耳容积、左心房容积、左上肺静脉口长径、左心耳空间形态与LVEF和LAAV呈负相关(β<1,P<0.05),与LVEDd、LAD呈正相关(β>1,P<0.05)。左心耳开口短径(OR=1.757,95%CI:1.239~1.971,P<0.001)、开口长径(OR=1.912,95%CI:1.348~2.019,P<0.001)、开口面积(OR=1.843,Objective To investigate the relationship among left atrial appendage structure,hemodynamics and left atrial appendage thrombosis(LAAT)reviewed by computed tomography angiography(CTA)in patients with non-valvular atrial fibrillation(NVAF).Methods NVAF patients(n=180)were chosen from Central Hospital of Tangshan City from Jan.2020 to Dec.2021,and all patients were given examinations of CTA and transesophageal echocardiography(TEE).Taken TEE detection results as gold standard,the consistency between CTA and TEE was reviewed by using Kappa test.The patients were divided,according to whether they had thrombosis or not,into thrombosis group(n=36)and non-thrombosis group(n=144),and clinical materials were collected from all patients.The relationship among parameters of left atrial appendage(LAA),hemodynamics and thrombosis was analyzed by using multi-factor Logistics regression analysis.The dose-response relationship between LAA parameters and thrombosis risk was estimated by using spline function method combined with Logistics regression.Results There were 36 LAAT cases detected(20.00%)by TEE,and taken this result as standard,there were 33 LAAT cases detected by CTA,and detection rate was 91.67%,missed diagnosis rate was 13.89%,and misdiagnosis rate was 1.39%.The diagnostic results of TEE and CTA were highly consistent(Kappa=0.836).The cases of heart failure(HF)were less,and level of N-terminal pro-brain natriuretic peptide(NT-proBNP),CHA2DS2-VASc scores and levels of D-dimer(D-D)and serum uric acid(SUA)were lower in non-thrombosis group than those in thrombosis group(P<0.05).The short diameter of LAA opening,long diameter of LAA opening,LAA opening area,LAA volume,left atrial volume,long diameter of left upper pulmonary vein opening,left ventricular end-diastolic diameter(LVEDd)and left atrial diameter(LAD)were higher,and left ventricular ejection fraction(LVEF)and left atrial appendage flow velocity(LAAV)were lower in non-thrombosis group than those in thrombosis group(P<0.05).The results of multi-factor Logistics r

关 键 词：非瓣膜性心房颤动 计算机断层扫描血管造影 经食道超声 左心耳 血流动力学 血栓 

分 类 号：R541.75[医药卫生—心血管疾病]