左侧俯卧位肺静脉CT成像对心房颤动患者左心耳血栓的检测价值

The Value of Left Prone-position Pulmonary Vein CT Angiography in the Diagnosis of Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation

目的 探讨左侧俯卧位肺静脉CT成像对房颤患者左心耳血栓的检测价值。方法 连续纳入2019年1月至2019年8月、房颤患者,术前接受肺静脉CT检查,左心耳内对比剂充盈不良者接受延迟扫描,于24h后接受左侧俯卧位肺静脉CT检查。1周内接受经食管超声心动图(TEE)检查。以TEE结果作为金标准,比较双期肺静脉CTA和左侧俯卧位肺静脉CTA对房颤患者心耳血栓的诊断效能。结果 120例心房颤动患者中,34例经TEE确诊左心耳血栓。左侧俯卧位肺静脉CTA较双期肺静脉CTA在检测左心耳血栓具有更高的敏感度(94.1%vs 88.2%)、特异度(100%vs 94.2%)、阳性预测值(100%vs 85.7%)和阴性预测值(97.7%vs 95.3%)(P值均<0.05)。左侧俯卧位肺静脉CTA评估左心耳血栓结果与TEE结果一致性更优(κ值0.97 vs 0.88,P<0.05)。结论 左侧俯卧位肺静脉CTA通过改变体位,改善对比剂在心耳内分布,提高对心耳血栓的检测效能,具有临床应用价值。

Objective To evaluate the value of pulmonary vein CT angiography with left prone position in detecting thrombosis in the left atrial appendage(LAA)among the patients with atrial fibrillation(AF).Methods From January 2019 to August 2019,consecutive patients with AF were collected in the department of cardiology of our hospital.Patients underwent regular supine-position dual-phase pulmonary vein CT angiography,and left prone-position pulmonary vein CT angiography 24 hours later.All patients underwent preoperative transesophageal echocardiography(TEE)within 1 week.The results of dualphase and left prone-position pulmonary vein CT angiography for detecting LAA thrombosis were compared with TEE as the gold standard.Results Of the 120 patients with AF,34 were detected with LAA thromosis using TEE.Left prone-position pulmonary vein CT angiography showed higher sensitivity(94.1%vs 88.2%),specificity,(100%vs 94.2%).positive predictive value(100%vs 85.7%)and negative predictive value(97.7%vs 95.3%)compared with dual-phase pulmonary vein CT angiography(P<0.05,respectively).Left prone-position pulmonary vein CT angiography also showed excellent agreement with TEE witthκvalue of 0.97,which is superior to dual-phase pulmonary vein CT angiography(κvalue 0.88).Conclusion Left prone-position pulmonary vein CT angiography improved the distribution of contrast agent and thus improve the diagnostic accuracy of LAA thrombosis in patients with AF.