二尖瓣病变合并持续性房颤患者二尖瓣峡部及冠状静脉窦的心脏CTA评估

Cardiac CTA evaluation of mitral isthmus and coronary sinus in patients with mitral valve disease accompanied with persistent atrial fibrillation

目的:应用心脏CTA(CCTA)评估二尖瓣病变合并持续性心房颤动(房颤)患者二尖瓣峡部(MI)及冠状静脉窦(CS)的结构特征并探讨其变化规律。方法:回顾性选取行CCTA扫描并经超声心动图、心电图诊断为中重度二尖瓣病变合并持续性房颤的患者(二尖瓣病变合并房颤组)、轻度或无二尖瓣病变的持续性房颤患者(房颤组)及窦性心律患者(对照组)各31例。收集3组患者的临床资料及CCTA数据。通过CT重建,测量所有患者的左心房容积、CS直径、二尖瓣峡部冠状静脉(MI-CV)直径、MI深度及曲线长度、MI-CV至左心房距离,并评估回旋支嵌入情况。结果:二尖瓣病变合并房颤组的左心房容积、CS直径、MI深度及曲线长度、MI袋形结构占比、肺动脉收缩压较房颤组、对照组均增大(均P<0.05);MI-CV直径、射血分数仅与对照组差异有统计学意义(均P<0.05),而较房颤组差异无统计学意义(均P>0.05)。回旋支嵌入占比、MI-CV至左心房距离3组比较,差异均无统计学意义(均P>0.05)。MI曲线长度与左心房容积呈强正相关(r=0.7911,P<0.05);MI深度与左心房容积呈中度正相关(r=0.3366,P<0.05);CS直径与肺动脉收缩压、左心房容积均呈中度正相关(r=0.4295,0.4447;均P<0.05),而与左室射血分数无相关性(P>0.05);MI-CV直径与肺动脉收缩压、左心房容积、射血分数均无相关性(均P>0.05)。结论:CCTA可精准化评估MI及CS结构特征。二尖瓣病变合并持续性房颤患者CS扩张可能与肺动脉压力增高有关,较大的左心房容积提示MI曲线长度延长的可能;二尖瓣病变合并持续性房颤患者较持续性房颤患者的MI曲线长度延长,MI更易形成袋形结构。

Objective:Cardiac CTA(CCTA)was used to evaluate the structural features of mitral isthmus(MI)and coronary sinus(CS)in patients with mitral valve disease(MVD)accompanied with persistent atrial fibrillation(PAF),and to explore their change laws.Methods:Three groups of patients who underwent CCTA and confirmed by echocardiography and electrocardiogram were retrospectively selected,including 31 cases of moderate to severe MVD with PAF patients(the MVD-PAF group),31 cases of PAF with or without mild MVD(the PAF group),and 31 cases of sinus rhythm with or without mild MVD(the control group).Their clinical and CCTA data were reviewed.With CT reconstruction,left atrial(LA)volume,CS diameter,MI coronary vein(MI-CV)diameter,MI depth,MI curve length(MICL),distance from MI-CV to LA were measured and the interposed circumflex coronary artery(ICCA)was evaluated.Results:LA volume,CS diameter,MI depth,MICL,proportion of pouched MI and pulmonary artery systolic pressure(PASP)were greater in the MVD-PAF group compared with those in the PAF and control group(all P<0.05).MI-CV diameter and ejection fraction(EF)in the MVD-PAF group had significant differences with those in the control group(both P<0.05),no differences with those in the PAF group(both P>0.05).There were no significant differences in the proportion of ICCA and distance from MI-CV to LA among the three groups(P>0.05).MICL had a strong positive correlation with LA volume(r=0.7911,P<0.05).MI depth had a moderate positive correlation with LA volume(r=0.3366,P<0.05).CS diameter had a moderate positive correlation with PASP and LAV(r=0.4295,0.4447;both P<0.05),and had no statistical correlation with EF(P>0.05).MI-CV diameter had no statistical correlations with PASP,LA volume and EF(all P>0.05).Conclusions:CCTA can accurately evaluate the structural characteristics of MI and CS.The dilatation of CS in MVD with PAF patients may be related to the increase of pulmonary artery pressure,and the larger LA volume indicates the possibility of prolonged MICL.MVD with PAF patients have longer MICL and are more likely to form pouched MI than PAF patients.