经三维食道超声心动图定量测量左心耳(LAA)周长在左心耳封堵术中的应用价值

Quantitive assessment of ostium perimeter in left atrial appendage (LAA) occlusion through three-dimension transesophageal echocardiogram

目的探讨非瓣膜性心房颤动患者行经导管左心耳(left atrial appendage,LAA)封堵术时,术前三维经食道超声心动图(transesophageal echocardiogram,TEE)、二维TEE、术中X线透视LAA造影下多个心耳解剖参数与最终置入LAA封堵器型号的关系。方法选取2018年1-3月于复旦大学附属中山医院接受LAA封堵器置入且完成术前二维、三维TEE的患者,并通过全身应用量化(QLAB 10.83DQ)软件,完善LAA最大、最小开口直径及周长衍生直径(perimeter derived diameter,PDD)测定,与最终置入封堵器型号作相关分析及线性回归分析。结果45位患者成功置入LAA封堵器,其测量结果显示LAA开口周长,二维、三维TEE下LAA开口最大径与最终手术置入LAA封堵器型号呈正相关(r=0.859,0.606,0.634,P<0.001)。根据封堵器型号选择说明,KAPPA分析显示三维TEE下LAA PDD预测的器械型号与最终置入封堵器的型号存在最佳一致性(K=0.778,P<0.001)。以三维TEE下PDD作为预测变量,最终选择封堵器型号为因变量,重新建立回归方程为:封堵器型号=0.9029×PDD+6.1012;其预测准确率达到87%。至6个月随访期结束,未出现封堵器移位、脱落、心包填塞、器械相关血栓及残余漏直径>3 mm等并发症。结论三维TEE下LAA周长能准确预测经导管LAA封堵术中封堵器型号的选择,该参数有助于进一步协助术者成功完成封堵并降低残余漏及器械回收率。

Objective To evaluate the relationship between left atrial appendage(LAA)ostium parameters with occluder size based on two-dimensional transesophageal echocardiogram(TEE)and three-dimensional TEE and angiography.Methods Patients successfully underwent LAA occlusion with complete acquirements of their pre-procedual two-dimensional TEE,three-dimensional TEE and LAA angiography records during Jan.2018 to Mar.2018 were included.Maximal and minimal dimensions of LAA orifice together with its perimeter derived diameter(PDD)were obtained and interpreted with QLAB 10.83 DQ software.Results Forty-five patients were finally included and their maximal ostium diameter derived from two-dimensional TEE,three-dimensional TEE and PDD proved a strong correlationship with the real type of occluder(r=0.606,0.634,0.859,P<0.001).KAPPA analysis demonstrated the best satisfactory agreement between predicted occluder size according to PDD and real-world device(K=0.778,P<0.001).Lineal regression analysis showed equations as follows:predicted occluder size=0.9029×(PDD)+6.1012,forecasting correct ratio measured as 87%.Adverse events represented as device displacement,device related thrombus,pericardial effusion and residual shunt around device>3 mm were not reported within 6-month follow-up.Conclusions Perimeter-derived diameter through three-dimensional TEE can facilitate appropriate sizing of LAA which may allow cardiologists to further reduce recapture and device change maneuvers.