血管造影术结合经食管超声心动图对左心耳形态的分析

Combination use of angiography and transesophageal echocardiography in analyzing left atrial appendage morphology

目的探讨血管造影术结合经食管超声心动图(TEE)在左心耳(LAA)大小及形态分析中的应用价值。方法 38例行LAA造影术患者术前行TEE检查,由2名观察者分别测量LAA开口最大径、深度,观察LAA形态,并与LAA造影术进行对比。结果 LAA造影术测量LAA开口径为(18.8±3.9)mm,2名TEE观察者测量分别为(17.8±3.8)mm、(18.6±4.0)mm,与LAA造影术测值的相关系数(r)分别为0.90、0.98(P<0.01);LAA造影术测量LAA深度为(25.5±5.7)mm,TEE分别为(26.5±6.1)mm、(26.5±5.9)mm,与LAA造影术测值的r分别为0.93、0.92(P<0.01)。TEE观察者之间Bland-Altman分析一致性较好。LAA造影显示LAA为鸡翅型15例,仙人掌型11例,风向袋型7例,菜花型5例,分别占39.5%、28.9%、18.4%、13.2%,其中35例与TEE一致,一致性达92.1%。结论 LAA血管造影术结合TEE更有助于观察LAA的大小及解剖形态,测量具有准确性及可靠性。

Objective To investigate the application of combination use of cardiac angiography and transesophageal echoeardiography （TEE） in analyzing the size and morphology of left atrial appendage （LAA）. Methods TEE was carried out in 38 patients before they underwent the angiography of LAA. The maximum diameter of LAA orifice and the depth of LAA were separately measured by 2 experienced echoeardiologists, the morphology of LAA was classified, and the resuhs were compared with angiographic findings. Results The maximum diameter of LAA orifice measured on LAA angiogram was （18.8±3.9） mm, which were （17.8±3.8） mm and （18.6±4.0） mm respectively measured by two independent echocardiologists on TEE, and the correlation coefficients with LAA angiography were 0.90 and 0.98 respectively （P〈0.01）. The depth of LAA measured on LAA angiogram was （25.5±5.7） mm, which were （26.5±611） mm and （26.5±5.9） mm respectively measured by two independent echocardiologists on TEE, and the correlation coefficients with LAA angiography were 0.93 and 0.92 respectively （P〈0.01）. The consistency of Bland-Altman analysis between the two TEE observers was good. LAA angiography demonstrated that LAA could be classified into chicken wing type （n= 15, 39.5%）, cactus type （n=1 1, 28.9%）, windsock type （n=7, 18.4%）, and cauliflower type （n=5, 13.2%）. Conclusion LAA angiography combined with TEE is more helpful for observation of the size and morphology of LAA, besides, the measurements are accurate and reliable.