双源CT评估心房颤动患者左心房及左心耳结构及功能重构

Dual-source CT observation on structure and function remodeling of left atrium and left atrial appendage in patients with atrial fibrillation

目的探讨应用双源CT评估心房颤动(AF)患者左心房及左心耳结构及功能改变,分析其与左心耳血栓形成的关系。方法回顾性分析84例AF患者(AF组)及对照组32例的心脏CT资料,以图像后处理软件测量左心房最大、最小容积(LAVmax、LAVmin)及左心耳最大、最小容积(LAAVmax、LAAVmin),计算左心房射血分数(LAEF)及左心耳射血分数(LAAEF)。根据临床症状将AF组患者分为阵发性AF亚组及持续性AF亚组,又根据是否存在左心耳血栓或"血栓前状态"分为AF左心耳血栓阳性亚组及阴性亚组,对左心房及左心耳容积及心功能指标进行统计学分析。结果 AF左心耳血栓两亚组LAVmax、LAVmin、LAAVmax及LAAVmin均明显高于对照组(P均<0.05),且AF左心耳阳性亚组LAVmax、LAVmin、LAAVmax及LAAVmin均高于阴性亚组(P均<0.01);AF左心耳血栓两亚组LAEF及LAAEF均明显低于对照组(P均<0.001),且AF左心耳阳性亚组LAEF及LAAEF均低于阴性亚组(P均<0.001)。持续性AF亚组LAEF及LAAEF均明显低于阵发性AF亚组(P均<0.01),阵发性AF亚组与持续性AF亚组间LAVmax、LAVmin、LAAVmax及LAAVmin差异均无统计学意义(P均>0.05)。持续性AF亚组左心耳血栓及"血栓前状态"发生率明显高于阵发性AF亚组[72.41%(21/29)vs 14.55%(8/55),χ2=113.46,P<0.001]。结论当AF患者存在左心耳血栓或"血栓前状态"时,左心房及心耳结构及功能重构更明显。

Objective To estimate the structure and function remodeling of left atrium（LA）and left atrial appendage（LAA）in patients with atrial fibrillation（AF）using dual-source CT,and to investigate the relation of LA and LAA remodeling and LAA thrombus in AF patients.Methods Cardiac CT examination data of 84 patients with AF（AF group）and 32 patients without AF（control group）were retrospectively analyzed.The left atrium maximum volume（LAVmax）,left atrium minimum volume（LAVmin）,left atrial appendage maximum volume（LAAVmax）and left atrial appendage minimum volume（LAAVmin）were segmented with post-processing software.Left atrium ejection fraction（LAEF）and left atrial appendage ejection fraction（LAAEF）were also calculated.Patients in AF group were divided into paroxysmal AF subgroup and persistent AF subgroup according to the clinical symptoms,and LAA thrombus positive subgroup and negative subgroup according to the existence of LAA thrombus or circulatory stasis.Statistical analysis was performed to compare the volume and function indexes of LA and LAA among different subgroups.Results LAVmax,LAVmin,LAAVmax and LAAVminin both subgroups of positive and negative LAA thrombus were significantly higher than those in control group（all P〈0.05）,and these indexes in thrombus positive subgroup were higher than those in thrombus negative subgroup（all P〈0.01）.LAEF,LAAEF in both subgroups of positive and negative LAA thrombus were significantly lower than those in control group（all P〈0.001）,and these indexes in thrombus positive subgroup were lower than those in thrombus negative subgroup（both P〈0.001）.LAEF and LAAEF in persistent AF subgroup significantly decreased than those in paroxysmal AF subgroup（both P〈0.01）,while no statistical difference of LAVmax,LAVmin,LAAVmaxnor LAAVmin was found（all P〉0.05）.LAA thrombosis or circulatory stasis was more likely to occur in persistent AF subgroup than paroxysmal AF subgroup（72.41% [21/29]vs 14.55%[8/55],χ2=113.46,P〈0.001）.Conclusion Thrombosis or circulatory stasis in AF patients closely related to structure and function remodeling of LA and LAA.