多排螺旋CT与Carto3三维电解剖标测系统重建左心房形态比较、及与CHA2DS2-VASc评分的相关性分析

Correlation analysis between left atrial morphology and CHA2DS2-VASc scores in multi-slice spiral CT and Carto3 three-dimensional electroanatomic mapping system

目的探讨多排螺旋CT(64排)术前与Carto3三维电解剖标测系统的术中重建左房三维结构的左心房形态的差异性、以及不同的左心房形态与CHA2DS2-VASc评分的相关性。方法收集2017年1月-2019年1月在新疆石河子市人民医院心血管内科成功行心房颤动经导管射频消融术的患者42例,男性42例(62.18%),女性28例(37.82%),平均年龄为64.69±10.52岁;所有患者必须至少有一份心电图或24 h动态心电图证实为房颤,且接受术前多排螺旋CT对左心房造影并进行图像的三维重建,术时为同一术者及同一技术人员利用Carto3三维电解剖标测系统构建左心房形态、测量前后径及容积大小,且全部研究对象均达到消融终点,比较两组的差异性及与CHA2DS2-VASc评分的相关性。结果(1)术前多排CT重建的左心房形态与同一术者术中使用Carto3三维电解剖标测系统重建的左心房形态比较,其左心房形态、左心房容积大小、左心房前后径,两组重建组间无统计学差异,且以左心房形态均以平坦型居多;(2)Spearman相关性分析提示CT重建组及Carto3三维电解剖标测系统重建组重建的左心房前后径与CHA2DS2-VASc评分之间存在显著正相关性,而与左心房容积大小之间无相关性。结论术前多排CT重建的左心房形态与同一术者术中使用Carto3三维电解剖标测系统重建的左心房有较高一致性,能够真实的反应出患者存在的左心房结构形态;左心房前后径越大可能与心房颤动相关的栓塞疾病发病率高有关。

Objective To investigate the morphological difference of left atrial three-dimensional structure and the relationship between different left atrial morphology and CHA2DS2-VASc scores in multi-slice spiral CT(64-row)preoperative and Carto3 three-dimensional electroanatomic mapping system.Methods From January 2017 to January 2019,42 patients who underwent radio frequency ablation of atrial fibrillation in the Department of Cardiology,People's Hospital of Shihezi,Xinjiang,China were chosen,and among them,there were 42 males(62.18%)and 28 females(37.82%).The mean age was 64.69±10.52 years.All patients must be confirmed having atrial fibrillation through at least one ECG or 24-hour Holter and were treated with preoperative multi-slice spiral CT to scan left atrial angiography and to get three-dimensional reconstruction of the image.In the same condition,the Carto3 three-dimensional electroanatomic mapping system were used to construct the left atrium morphology,and to measure the anteroposterior diameter and volume.All subjects reached end point of the ablation.The differences between the two groups and the correlation with the CHA2DS2-VASc score were compared.Results(1)The left atrial morphology of preoperative multi-slice CT reconstruction was compared with the left atrial morphology reconstructed through the Carto3 three-dimensional electroanatomic mapping system.The left atrial morphology,left atrial volume,left atrial anteroposterior diameter were determined.There was no statistical difference between the two groups,and the left atrial morphology was mostly flat;(2)Spearman correlation analysis suggested that the left atrial anteroposterior diameter and CHA2DS2-VASc between the CT reconstruction group and the Carto3 three-dimensional electroanatomic mapping system reconstruction group had significantly positive correlation,while no correlation was observed with the volume of the left atrium.Conclusion the left atrium morphology reconstructed by multi-row CT was highly consistent with that of the same operator using the Carto3 3d electroanatomical mapping system.The larger anteroposterior diameter of the left atrium may be related to the higher incidence of atrial fibrillation related embolism.