左心耳开口形态预测左心耳封堵残余漏的临床研究

Clinical study of left atrial appendage opening shape in predicting residual leakage of left atrial appendage closure

目的:应用经食管超声心动图评估左心耳封堵患者的左心耳开口形态,探讨左心耳开口形态对左心耳封堵(LAAC)残余漏的预测价值。方法:选择LAAC患者118例,术前应用经食管超声心动图测量0°~135°左心耳开口内径以及最大内径,计算左心耳开口椭圆率、扁率。术后即刻观察左心耳封堵器残余漏情况,分析预测LAAC残余漏的左心耳形态学指标。结果:118例患者中53例发生残余漏(44.92%),与无残余漏组比较,残余漏组左心耳开口最大径、135°左心耳口内径增大(P<0.001)、椭圆率减小(P<0.001)、扁率增大(P<0.05)。ROC曲线分析显示:左心耳开口扁率(截点值为0.19)预测LACC残余漏的曲线下面积为0.816、灵敏度为69.80%、特异度为81.50%;左心耳口椭圆率(截点值为0.80)的曲线下面积为0.839、灵敏度为67.92%、特异度为84.62%;135°左心耳口内径(截点值为22 mm)的曲线下面积为0.753、灵敏度为56.60%、特异度为87.69%;左心耳开口最大径(截点值为21 mm)的曲线下面积为0.740、灵敏度为79.25%、特异度为61.54%。结论:左心耳口最大内径、扁率、左心耳开口椭圆率以及135°左心耳口内径是预测LAAC术后封堵器残余漏的形态学指标。

Objective: Using transesophageal echocardiography to evaluate the shape of the left atrial appendage opening in patients, and to investigate the predictive value of the shape of the left atrial appendage opening in patients with residual leakage of left atrial appendage closure(LAAC). Methods: The 118 patients who underwent LAAC were selected. Preoperative transesophageal echocardiography was used to measure the internal diameter of the left atrial appendage opening from 0° to 135° and the maximum internal diameter. We Calculated the ellipticity and flattening of the left atrial appendage opening. The residual leakage of the left atrial appendage was observed immediately after surgery, and the shape parameter of the left atrial appendage was analyzed and predicted. Results: Residual leakage occurred in 53 of 118 patients(44.92%). Compared with the group without residual leakage, the maximum diameter, the internal diameter of the left atrial appendage opening at 135° was increased(P<0.001), the ellipticity was decreased(P<0.001), and the flattening was increased(P<0.05) in the residual leakage group. ROC curve analysis showed that the area under curve(AUC), the sensitivity and the specificity of flattening of left atrial appendage opening(cutoff value was 0.19) for predicting residual leakage of left atrial appendage were 0.816, 69.80% and 81.50%, respectively;ellipticity(cutoff value was0.80) were 0.839, 67.92% and 84.62%, the diameter at 135°(cutoff value was 22 mm) were 0.753, 56.60% and 87.69%, and the maximum diameter(cutoff value was 21 mm) were 0.740, 79.25% and 61.54%, respectively. Conclusion: The maximum internal diameter of the left atrial appendage opening, the flattening, the ellipticity of the left atrial appendage opening, and the 135° left atrial appendage openging internal diameter are morphological predictors of residual leakage after LAAC.