256层螺旋CT定量评估左心耳结构与卒中的相关性

Quantitative study of relationship between left atrial appendage structure and stroke by 256-slice spiral CT

目的 采用256层螺旋CT对左心耳结构进行定量测量,评估其与非瓣膜性房颤患者发生脑卒中风险的相关性。方法 选取房颤患者80例,其中有脑卒中病史的40例为房颤伴卒中组,按照年龄及性别配对的方式选取同期40例房颤无脑卒中病史患者为房颤非卒中组。选用冠状动脉CTA 75%期相图像进行后处理,获取房颤患者的左心耳结构参数,对所得数据进行统计学分析。结果 1)房颤伴卒中组与房颤非卒中组比较,左心耳容积(LAAV)、左心耳容积指数(LAAVi)、左心耳开口面积、长径及短径均大于非卒中组(P<0.05)。以上数值增大,发生脑卒中的风险几率增加;2)当房颤患者左心耳容积>8.7 ml,预测发生脑卒中风险的价值最高,特异性达90.0%。结论 左心耳容积、容积指数、开口面积、长径及短径增大是房颤患者发生脑卒中的重要危险因素,当左心耳容积>8.7 ml脑卒中风险增加,该结果对临床指导房颤患者抗凝治疗具有重要临床意义。

Objective 256-slice spiral CT was used to quantitatively measure the structure of the left atrial appendage, and to evaluate its correlation with the risk of stroke in patients with nonvalvular atrial fibrillation. Methods This study selected 80 patients with AF. In this study, 40 patients had a history of stroke. According to age and gender matching, 40 atrial fibrillation patients with no history of stroke were selected as the non-stroke group. All patients with atrial fibrillation underwent coronary artery CT, and 75% of phase images were used for post-processing to obtain the left atrial appendage anatomical structure parameters of all patients. The data were statistically analyzed. Results 1)Comparing the two groups-the atrial fibrillation patients with and without stroke, the left atrial appendage volume(LAAV), left atrial appendage volume index(LAAVi), left atrial appendage orifice area, long diameter of the left atrial appendage orifice, short diameter of the left atrial appendage were larger in the atrial fibrillation with stroke group than in the non-stroke group(P<0.05);all those anatomical structure parameters were increased, and the risk of stroke was higher;2)The ROC curve showed that if the left atrial appendage volume >8.7 ml, the patients with atrial fibrillation will have higher stroke risk(sensitivity, 40.0%, specificity, 90.0%). Conclusion The left atrial appendage volume, left atrial appendage volume index, left atrial appendage orifice area, Left atrial appendage orifice long axis and short axis get largerer, the risk of stroke is increased. ROC curve shows that when the left atrial appendage volume of patients with atrial fibrillation greater than 8.7 ml, the risk of stroke is increased. This result has important clinical significance for clinically guiding anticoagulation therapy in patients with atrial fibrillation.