房颤病人左心耳解剖形态学特征和容积与年龄的相关性

Relationship between the anatomical and morphological characteristics,volume of left atrial appendage and age in patients with atrial fibrillation

目的采用多层螺旋计算机断层扫描(MSCT)评价房颤病人左心耳(LAA)解剖形态学特征及容积,并探讨其与年龄的相关性。方法连续性收集2019年8月至2021年8月我院收治的阵发性房颤病人92例,术前均接受MSCT检查,并进行三维容积重建,观察LAA解剖形态学特征、矫正后容积,并分析其与年龄的关系。结果92例房颤病人的LAA内均可见丰富的梳状肌及肌小梁,凹凸不平,表面存在分叶,形态不规整,其中鸡翅型LAA占60.9%,非鸡翅型占39.1%,LAA校正后平均容积为(6.7±4.8)mL/m^(2)。随着LAA校正后平均容积的增加,房颤病人非鸡翅型LAA比例增加。≥65岁病人LAA校正后平均容积≥6.7 mL/m 2比例明显高于<65岁病人。Pearson相关分析结果显示,房颤病人LAA校正后平均容积与年龄呈正相关(r=0.429,P=0.009)。此外,随着年龄的增加,非鸡翅型LAA比例增加。单因素及二分类Logistic回归分析结果显示,年龄、房颤病程及LAA校正后平均容积均为非鸡翅型LAA发生的独立影响因素。结论非鸡翅型LAA的分布与年龄有关。临床考虑使用非鸡翅型LAA评估房颤病人卒中风险的因素时需充分考虑病人年龄的影响。

Objective To investigate the anatomical and morphological characteristics and volume of left atrial appendage(LAA)in the patients with atrial fibrillation evaluated by multi-slice spiral computed tomography(MSCT),and to investigate the relationship with age.Methods A total of 92 patients with paroxysmal atrial fibrillation treated in our hospital from August 2019 to August 2021 were continuously enrolled.All the patients underwent MSCT and three-dimensional volume reconstruction before operation.The anatomical and morphological characteristics and corrected volume of LAA under MSCT were observed,and the relationship between LAA and age was analyzed.Results The LAA of 92 patients with atrial fibrillation showed abundant comb muscles and muscle trabeculae,lobulated surface and irregular shape.Among them,chicken wing type LAA accounted for 60.9%,and the average volume after LAA correction was 6.7±4.8 mL/m 2.With the increase of average volume after LAA correction,the proportion of non-chicken wing LAA increased.The proportion of LAA corrected mean volume≥6.7 mL/m^(2)in the elderly patients aged≥65 years old was significantly higher than that in the patients aged<65 years old.Pearson correlation analysis showed that the average volume after LAA correction was significantly positively correlated with age in the patients with atrial fibrillation(r=0.429,P=0.009).In addition,the proportion of non-chicken wing LAA increased with age.Univariate and binary Logistic regression analysis showed that age,duration of atrial fibrillation and LAA corrected mean volume were the independent influencing factors for the occurrence of non-chicken wing LAA.Conclusions The distribution of non-chicken wing LAA was positively correlated with age.The influence of age should be fully considered when using non-chicken wing LAA to evaluate the risk factors of stroke in patients with atrial fibrillation.