经食管超声心动图诊断房颤患者左心房/左心耳内血栓的临床价值

Clinical value of transesophageal echocardiography in diagnosis of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation

目的探讨经食管超声心动图诊断房颤患者左心房/左心耳内血栓的临床价值。方法选取该院2015年5月‐2017年5月收治的心房震颤患者120例为本研究观察组,其中阵发性震颤107例、持续性震颤13例;选取同期入该院体检的心功能正常的健康志愿者120例为本研究对照组。观察组患者均接受肺静脉隔离(PVI)治疗,并于术前行经食管超声心动图检测左心房及左心耳内血栓情况;比较观察组与对照组患者左心房/左心耳超声心动图参数、伴有和不伴有自发性显影的房颤患者超声心动图参数;并利用受试者工作特征曲线(ROC曲线)分析超声心动图对左心房/左心耳内血栓的诊断价值。结果阵发性房颤组患者左心房前后径、左心房左右径和左心耳最大的排空速度(Lev)均明显低于对照组(P<0.05);阵发性房颤组患者左心耳面积变化率以及左心耳最大的充盈速度(Lfv)均明显大于对照组(P<0.05);持续性房颤组患者左心房前后径、左心房左右径均明显大于对照组和阵发性房颤组患者(P<0.05);持续性房颤组患者左心耳面积变化率、左心耳Lev以及左心耳Lfv均明显小于对照组和阵发性房颤组患者(P<0.05);120例房颤患者中有自发性显影41例,无自发性显影79;有自发性显影组患者左心房前后径、左心房左右径均明显大于无自发性显影组患者(P<0.05);有自发性显影组患者左心耳面积变化率、左心耳Lev以及左心耳Lfv均明显小于无自发性显影组患者(P<0.05);观察组患者经食管超声心动图诊断敏感度为90.63%,特异度为92.05%,阳性预测值(PPV)为80.56%,阴性预测值(NPV)为96.43%;ROC曲线分析显示曲线下面积为0.913(0.846,0.980)。结论经食管超声心动图能有效评价房颤患者左心房/左心耳的状况,对房颤患者左心房/左心耳内血栓的诊断具有较高应用价值。

[Objective] To evaluate the clinical value of transesophageal echocardiography in the diagnosis of thrombosis in left atrium or left atrial appendage in patients with atrial fibrillation. [Methods] A total of 120 cases of atrial fibrillation admitted in our hospital from May 2015 to May 2017 were selected as the observation group, including 107 cases of paroxysmal tremor and 13 cases of persistent tremor, and 120 healthy volunteers with normal cardiac function were selected as the control group. Patients in the observation group were treated with pulmonary vein isolation （PVI） and preoperative esophageal echocardiography was used to detect thrombosis in the left atrium and left atrial appendage. The parameters of left atrial/left atrial appendage echocardiography and the echocardiographic parameters of patients with atrial fibrillation with or without spontaneous manifestation between the two groups were compared. The value of echocardiography in diagnosis of left atrial/left atrial appendage thrombus was analyzed using Receiver Operating Characteristic （ROC） curve. [Results] The left atrial anteroposterior diameter, left-right diameter of left atrium, and left atrial appendage peak emptying velocity （Lev） in paroxysmal atrial fibrillation group were significantly lower than those in the control group （P 〈0.05）. The area change rate of left atrial appendage and left atrial appendage peak flow velocity （Lfv） in paroxysmal atrial fibrillation group were significantly larger than those in the control group （P 〈0.05）. The left atrial anteroposterior diameter and left-right diameter of left atrium in the persistent atrial fibrillation group were significantly larger than those in the control group and paroxysmal atrial fibrillation group （P 〈0.05）. The area change rate of left atrial appendage, Lev and Lfv in persistent atrial fibrillation group were significantly smaller than those in the control group and paroxysmal atrial fibrillation group （P 〈0.05）. In 120 patients with atrial fibrillation, 41 cases had spontaneous echo contrast and 79 cases had not. Left atrial anteroposterior diameter and left-right diameter of left atrium in spontaneous echo contrast group were significantly lager than those in non-spontaneous echo contrast group （P 〈0.05）. The area change rate of left atrial appendage, Lev and Lfv in spontaneous echo contrast group were significantly smaller than those in non-spontaneous echo contrast group （P 〈0.05）. In the observation group, the diagnostic sensitivity of transesophageal eehocardiography was 90.63%, the specificity was 92.05%, the positive predictive value （PPV） was 80.56%, and the negative predictive value （NPV） was 96.43%. The ROC curve showed that the area under the curve was 0.913 （0.846, 0.980）. [Conclusion] Transesophageal echocardiography can effectively evaluate the status of left atrium/left atrial appendage in patients with atrial fibrillation and has a high value in the diagnosis of thrombus in left atrium/left atrial appendage in patients with atrial fibrillation.