心脏CT血管造影三维重建定量左心耳口部周长选择封堵器型号

Quantifying perimeter of left atrial appendage opening based on three-dimensional reconstruction of cardiac CT angiography for selecting occluder size

目的观察心脏CT血管造影(CTA)三维重建定量左心耳(LAA)口部周长对选择左心耳封堵术(LAAC)治疗房颤(AF)所用封堵器型号的价值。方法基于术前心脏CTA三维重建、经食管超声心动图(TEE)及术中LAA造影测量94例接受LAAC AF患者LAA口部最大长径,基于心脏CTA三维重建测量LAA口部周长、计算周长衍生直径(PDD)。分析LAA口部参数与植入封堵器型号的相关性及一致性,评估以各种方法所获LAA口部参数预测与实际植入封堵器型号的一致性;以LAA PDD为预测变量、植入封堵器型号为因变量建立线性回归方程。结果实际植入封堵器型号(真实直径)为(28.95±3.13)mm,周长为(90.90±9.82)mm。心脏CTA、TEE及术中LAA造影所测LAA口部最大长径分别为(24.63±3.17)mm、(24.07±3.19)mm及(23.17±3.25)mm,均与封堵器型号呈正相关(r=0.814、0.691、0.790,P均<0.001);基于心脏CTA所测LAA口部周长为(78.48±10.69)mm,PDD为(24.98±3.40)mm;LAA口部周长与封堵器周长呈正相关(r=0.842,P<0.001)。3种方法所测LAA口部最大长径及LAA PDD与植入封堵器型号的一致性均较好(ICC=0.88、0.85、0.86、0.92),预测植入型号的一致性为中等或强(Kappa=0.653、0.539、0.618、0.821)。以与植入封堵器型号相关性较好(r>0.650)30例的LAA PDD为预测变量、植入封堵器型号为因变量,获得线性回归方程:封堵器型号=0.9348×LAA PDD+4.9912,其预测准确率为85.31%。结论基于术前心脏CTA三维重建定量LAA口部周长可预测LAAC治疗AF所用封堵器型号。

Objective To explore the value of quantifying the perimeter of left atrial appendage(LAA)opening based on three-dimensional reconstruction of cardiac CT angiography(CTA)for selecting occluder size used in left atrial appendage closure(LAAC)for treating atrial fibrillation(AF).Methods The maximum LAA opening diameter was measured based on three-dimensional reconstruction of preoperative cardiac CTA,transesophageal echocardiogram(TEE)and intraoperative LAA angiography for 94 AF patients.The perimeter of LAA opening was measured,and the perimeter derived diameter(PDD)was calculated based on three-dimensional reconstruction of cardiac CTA.The correlations and consistencies of LAA opening parameters and the implanted occluder size were analyzed,and the consistencies of occluder size predicted with LAA opening parameters obtained with different methods and implanted were evaluated.Taken LAA PDD as predictive variable and the implanted occluder size as dependent variable,a linear regression equation was established.Results The size(real diameter)of the implanted occluder was(28.95±3.13)mm,with perimeter of(90.90±9.82)mm.The maximal LAA opening diameter derived from cardiac CTA,TEE and LAA angiography was(24.63±3.17)mm,(24.07±3.19)mm and(23.17±3.25)mm,respectively,all positively correlated with the occluder size(r=0.814,0.691,0.790,all P<0.001).The LAA opening perimeter based on cardiac CTA was(78.48±10.69)mm,PDD was(24.98±3.40)mm,and the LAA opening perimeter was positively correlated with the circumference of occluder(r=0.842,P<0.001).The maximal LAA opening diameters derived from cardiac CTA,TEE and LAA angiography and LAA PDD had good consistencies with the implanted occluder size(ICC=0.88,0.85,0.86,0.92),and the consistencies of the size of the predicted and implanted occluder were moderate to strong(Kappa=0.653,0.539,0.618,0.821).Taken LAA PDD of 30 AF patients having good correlation with the implanted occluder size(r>0.650)as predictive variable and the latter as dependent variable,a lineal regression equation was obtained,i.e.the predicted occluder size=0.9348×LAA PDD+4.9912,with predicting accuracy of 85.31%.Conclusion Quantifying LAA opening perimeter based on three-dimensional reconstruction of cardiac CTA could predict occluder size in LAAC for treating AF.