基于左心耳早期血流淤滞CT特征定量预测心房颤动患者发生心源性脑卒中的风险  

Risk prediction of cardiogenic stroke in patients with atrial fibrillation using quantitative CT features of early left atrial appendage blood stasis

作　　者：顾海蓉 徐琦 刘源超 李磊 明佳蕾 郑扣龙[2] 盛国华 施林生[2] 祁荣兴[1] Gu Hairong;Xu Qi;Liu Yuanchao;Li Lei;Ming Jialei;Zheng Koulong;Sheng Guohua;Shi Linsheng;Qi Rongxing(Department of Radiology,Affiliated Hospital 2 of Nantong University,Nantong 226001,China;Department of Cardiology,Affiliated Hospital 2 of Nantong University,Nantong 226001,China;Department of Cardiology,Nantong Haimen People′s Hospital,Nantong 226000,China)

机构地区：[1]南通大学第二附属医院影像科,南通226001 [2]南通大学第二附属医院心内科,南通226001 [3]南通市海门区人民医院心内科,南通226000

出　　处：《中华放射学杂志》2025年第3期299-306,共8页Chinese Journal of Radiology

基　　金：江苏省卫生健康委员会科研项目(Z2023048,LKM2022060);南通市科技局基础科学研究项目(JC22022032,JC2021195);南通市卫生健康委员会青年指导项目(QNZ2022009,QNZ2022010)。

摘　　要：目的利用左心房-肺静脉CT检查定量分析阵发性心房颤动(PAF)患者早期左心耳血流淤滞(LAA-BS)的征象,评估其对心源性脑卒中(CS)发生风险的预测价值。方法回顾性纳入2019年1月至2021年12月于南通大学第二附属医院行左心房-肺静脉CT检查且存在LAA-BS的PAF患者187例。测量主动脉增强峰值时LAA-BS的CT值与升主动脉(AA)CT值之比(HU_(BS)/HU_(AA))和LAA-BS容积与LAA容积之比(V_(BS)/V_(LAA))作为LAA-BS的特征量化指标。将HU_(BS)/HU_(AA)和V_(BS)/V_(LAA)以中位数作为分组的截断值,比较高、低分组在一般资料、临床特征及影像学特征上差异。对所有入组患者进行随访,主要结局事件为CS发生,比较高、低分组CS发生比例的差异。使用Kaplan-Meier曲线对PAF患者CS的发生进行风险分层分析,并采用Cox比例风险回归模型评估HU_(BS)/HU_(AA)、V_(BS)/V_(LAA)及其他影像指标对CS发生风险的预测价值。结果V_(BS)/V_(LAA)高分组患者的高血压发生率及心房颤动-卒中风险评分(CHA 2DS 2-VASc)≥3分的比例都高于低分组,差异具有统计学意义(P=0.041、P=0.011)。HU_(BS)/HU_(AA)低分组患者左心房容积(LAV)大于高分组,差异具有统计学意义(P=0.040)。Kaplan-Meier分析显示,HU_(BS)/HU_(AA)低分组CS发生率高于高分组(P=0.012),V_(BS)/V_(LAA)高分组CS发生率高于低分组(P=0.019),亚组分析显示低HU_(BS)/HU_(AA)+高V_(BS)/V_(LAA)组的CS发生率均显著高于其他亚组(P均<0.05)。Cox比例风险回归模型显示,在调整混杂因素后,HU_(BS)/HU_(AA)和V_(BS)/V_(LAA)仍与PAF患者CS的发生相关(P=0.005、P=0.029)。结论左心房-肺静脉CT成像量化的HU_(BS)/HU_(AA)和V_(BS)/V_(LAA)是PAF患者CS发生的独立预测因子。低HU_(BS)/HU_(AA)和高V_(BS)/V_(LAA)对CS的风险评估有协同作用。ObjectiveTo assess the predictive value for the risk of cardiogenic stroke(CS)in patients with paroxysmal atrial fibrillation(PAF)using quantification of left atrial appendage early blood stasis(LAA-BS)signs derived from left atrium-pulmonary vein CT examination.MethodsA retrospective analysis of 187 patients with PAF,who were confirmed to have LAA-BS by left atrium-pulmonary vein CT examinations,was conducted at Second Affiliated Hospital of Nantong University from January 2019 to December 2021.The ratio of LAA-BS CT values to ascending aorta(AA)CT values(HU_(BS)/HU_(AA))and the ratio of LAA-BS volume to LAA volume(V_(BS)/V_(LAA))were measured at the peak time of AA enhancement,which were used as characteristic quantitative indicators of LAA-BS.Using the median values of HU_(BS)/HU_(AA)and V_(BS)/V_(LAA)as cut-off points for grouping,the differences between the high-ratio and low-ratio groups were compared in terms of general information,clinical characteristics,and imaging characteristics.All enrolled patients were followed up with the primary outcome event of CS occurrence.The differences in the proportion of CS occurrence between the high-ratio and low-ratio groups were compared.The risk stratification analysis of the occurrence of CS in PAF patients was performed using Kaplan-Meier curves.Additionally,the predictive value of HU_(BS)/HU_(AA),V_(BS)/V_(LAA)and other imaging indices for the risk of CS occurrence was assessed using Cox proportional risk regression models.ResultsThe incidence of hypertension and the proportion of patients with atrial fibrillation-stroke risk score(CHA 2DS 2-VASc)≥3 in the high V_(BS)/V_(LAA)group were higher than that in the low V_(BS)/V_(LAA)group,and the difference was statistically significant(P=0.041,P=0.011).The left atrial volume(LAV)in patients in the low HU_(BS)/HU_(AA)group was greater than in the high HU_(BS)/HU_(AA)group,and the difference was statistically significant(P=0.040).Kaplan-Meier analysis showed a higher incidence of CS in the low HU_(BS)/HU_(AA)group than

关 键 词：卒中 心房颤动 心耳 预测 

分 类 号：R54[医药卫生—心血管疾病]