经食管超声心动图与双源CT诊断心房颤动患者左心耳血栓及相关临床资料分析

Comparison of transesophageal echocardiography and dual source CT in diagnosis of left atrial appendage thrombus in atrial fibrillation patients and analysis of related clinical data

目的 探讨肺静脉隔离（PVI）术前经食管超声心动图（TEE）与双源CT（DSCT）诊断心房颤动（AF）患者左心耳血栓的应用价值。方法 回顾性分析338例拟接受PVI治疗的AF患者资料。所有患者PVI术前均接受TEE及DSCT检查。TEE显示左心房或左心耳血栓为阳性,DSCT显示造影剂充盈缺损为阳性。以TEE结果为“金标准”,评价DSCT诊断左心耳血栓的敏感度、特异度、准确率、阳性预测值及阴性预测值。并比较TEE检查阳性与阴性患者及DSCT检查阳性与阴性患者的相关检查资料。结果 经TEE确诊为左心耳血栓22例（22/338,6.51%）,DSCT诊断左心耳血栓42例（42/338,12.43%）,差异有统计学意义（χ2=134.70,P〈0.01）。22例DSCT阳性而TEE阴性者中,11例（11/22,50.00%）TEE显示血流缓慢引起的自发显影,比率明显高于DSCT阴性组（4/296,1.35%）,差异有统计学意义（χ2=109.30,P〈0.01）。DSCT的诊断敏感度为90.91%（20/22）,特异度为93.04%（294/316）,准确率为92.90%（314/338）,阳性预测值为47.62%（20/42）,阴性预测值为99.32%（294/296）。TEE及DSCT检查中,阳性患者左心房前后径、横径及上下径均大于阴性患者,左心室射血分数（LVEF）低于TEE阴性患者,差异均有统计学意义（P均〈0.05）。TEE阳性患者中LVEF〈50%的比例（27.27%,6/22）高于TEE阴性患者（7.91%,25/316;χ2=7.01,P〈0.01）。结论 DSCT有助于诊断AF患者左心耳血栓,其特异度及阴性预测值均较高,但阳性预测值较低。

Objective To evaluate the application value of transesophageal echocardiography （TEE） and dual source CT （DSCT） in diagnosis of thrombus in patients with atrial fibrillation （AF） before pulmonary vein isolation （PVI）. Methods Data of 338 patients with AF proposed treated .by PVI were retrospectively analyzed. TEE and DSCT were performed be- fore PVI. The positive result of TEE was described as left atrial thrombus, and of DSCT was contrast agent filling defect, respectively. Taking TEE as the ＂gold standard＂, the sensitivity, specificity, accuracy, positive predictive value and nega- tive predictive value of DSCT for the diagnosis of left atrial thrombus were evaluated. The relevant data were compared be- tween the TEE positive and negative patients, as well as DSCT positive and negative patients. Results Totally there were 22 cases （22/338,6.51%） of TEE positive results and 42 cases （42/338, 12.43%） of DSCT positive results, The difference were statistically significant （χ2 134. 70, P〈0. 01）. DSCT positive and TEE negative results were found in 22 cases. Among them, 11 cases （11/22, 50.00%） showed spontaneous echo contrast resulted from slow blood flow. The ratio was significantly higher than that of DSCT negative patients （4/296, 1.35% ;χ2= 109.30, P〈0. 01）. Taken TEE as the ＂golden standard＂, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of DSCT was 90.91% （20/22）, 93.04% （294/316）, 92.90% （314/338）, 47.62% （20/42） and 99.32% （294/296）, respectively. For both of TEE and DECT, the larger left atrium （anteroposterior diameter, transverse diameter and vertical diameter） and lower left ventricular ejection fraction （LVEF） were found in patients with positive results than those with negative re- sults （all P〈0.05）. The percentage of LVEF〈50% in TEE positive patients （27.27%, 6/22） was significantly higher than that in TEE negative patients （7.91%, 25/316;χ2=7.01, P〈0.01）. Conclusion Defection of left atrial appendage thrombosis by DSCT has high specificity and negative predictive value. But the positive predictive value is low.