CT血管造影成像与超声心动图在预测非瓣膜性心房颤动患者左心耳血栓形成中的应用

Application of CT angiography and echocardiography in predicting left atrial appendage thrombus in patients with non-valvular atrial fibrillation

目的:探究CT血管造影成像与超声心动图在预测非瓣膜性心房颤动(房颤)患者左心耳血栓形成中的应用。方法:回顾性分析2015年2月—2020年2月接受心脏CT血管造影(CTA)与经食管三维超声心动图(RT-3D-TEE)的164例房颤患者的临床资料,根据房颤血栓危险度评分(CHA2DS2-VASc)分为A组(112例)和B组(52例)。对比两组患者的一般资料、CTA结果与RT-3D-TEE测量参数,对比CTA与RT-3D-TEE对左心耳血栓的诊断结果,使用Spearman相关系数分析CHA2DS2-VASc评分与CTA左心耳分型、RT-3D-TEE测量参数的相关性,用受试者工作特征曲线(ROC)分析CTA、RT-3D-TEE、CHA2DS2-VASc评分对左心耳血栓的预测价值。结果:RT-3D-TEE检查结果显示,A组左心耳血栓16例,无血栓96例,CTA检查灵敏度为87.50%(14/16)、特异度为94.79%(91/96)、准确度为93.75%(105/112)、阳性预测值为73.68%(14/19)、阴性预测值为97.85%(91/93)。B组左心耳血栓11例,无血栓41例,CTA检查灵敏度为72.73%(8/11)、特异度为90.24%(37/41)、准确度为86.54%(45/52)、阳性预测值为66.67%(8/12)、阴性预测值为92.50%(37/40)。CHA2DS2-VASc评分与菜花型左心耳、左心耳开口最大径、左心耳开口最小径、左心耳开口面积、左心耳深度、左心耳容积最大值、左心耳容积最小值、左心房内径呈正相关(P<0.001),与左心耳射血分数、左心室射血分数呈负相关(P<0.001)。ROC曲线分析结果显示CTA、RT-3D-TEE与CHA2DS2-VASc评分预测房颤患者左心耳血栓形成的AUC分别为0.762、0.814、0.792。结论:CTA对房颤患者左心耳血栓形成具有较高的预测价值,CHA2DS2-VASc评分越高准确性越大。

Objective: To explore the application of CT angiography and echocardiography in predicting left atrial appendage thrombosis in patients with non-valvular atrial fibrillation. Methods: A retrospective analysis of the clinical data of 164 patients with atrial fibrillation who underwent cardiac computed tomographic angiography(CTA) and real time three-dim ensional transesophageal echocardiography(RT-3D-TEE) from February 2015 to February 2020. According to the CHA2DS2-VASc score, the patients were divided into group A(112 cases) and group B(52 cases). We compared the general data, CTA results and RT-3D-TEE measurement parameters of the two groups of patients. Spearman correlation coefficient was analyzed the correlation between CHA2DS2-VASc score and CTA left atrial appendage classification and RT-3D-TEE measurement parameters. The value of CTA, RT-3D-TEE and CHA2DS2-VASc scores in predicting left atrial appendage thrombus was analyzed by receiver operating characteristic curve(ROC). Results: The results of RT-3D-TEE showed that there were 16 cases of left atrial appendage thrombus and 96 cases of no thrombus in group A. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA were 87.50%(14/16), 94.79%(91/96), 93.75%(105/112), 73.68%(14/19) and 97.85%(91/93) respectively. In group B, there were 11 cases of left atrial appendage thrombosis and 41 cases of no thrombus. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA were 72.73%(8/11), 90.24%(37/41), 86.54%(45/52), 66.67%(8/12) and 92.5%(37/40), respectively. CHA2DS2-VASc score was positively correlated with cauliflower left atrial appendage, maximum diameter of left atrial appendage opening, minimum diameter of left atrial appendage opening, area of left atrial appendage opening, depth of left atrial appendage, maximum volume of left atrial appendage, minimum volume of left atrial appendage, LAD(P<0.001), and negatively correlated with ejection fraction of left atrial appendage, LVEF(P<0.001). ROC curve analysis showed that the AUC of CTA, RT-3D-TEE and CHA2DS2-VASc scores for predicting left atrial appendage thrombosis in patients with atrial fibrillation were 0.762, 0.814 and 0.792, respectively. Conclusion: CTA has a higher predictive value for left atrial appendage thrombosis in patients with atrial fibrillation. The higher the CHA2DS2-VASc score, the greater the accuracy.