CTA定量评价广西壮族人群非瓣膜性房颤患者左心耳结构与血栓形成关联性及意义

Quantitative Evaluation of The Association Between Left Heart Ear Structure and Thrombosis and Significance of CTA in A Guangxi Zhuang Population with Non-valvular Atrial Fibrillation

目的探讨计算机断层扫描血管造影(CTA)定量评价广西壮族人群非瓣膜性房颤患者左心耳结构与血栓形成的关系。方法选取2020年7月~2022年6月崇左市人民医院、钦州市第一人民医院、柳州市工人医院180例广西壮族人群非瓣膜性房颤患者,均行经食道超声心动图(TEE)、心脏CTA检查,以TEE为标准,统计CTA诊断左心耳血栓价值,分析CTA与TEE评价左心耳空间形态的一致性。根据TEE左心耳是否有血栓分为血栓组(80例)、无血栓组(100例),比较两组一般资料、开口长径、开口短径、开口周长、左心房容积、左心耳容积、左上肺静脉口长径、左心耳空间形态,经Logistic回归方程分析左心耳血栓形成的相关影响因素。结果经CTA检查共检出左心耳血栓77例,诊断敏感度为92.50%(74/80),特异度为97.00%(97/100);C T A评价左心耳空间形态与T E E的一致性为98.89%(178/180),Kappa值为0.983(95%CI:0.891~1.075)(P<0.05);血栓组开口短径、开口长径、开口周长、左心耳容积、左心房容积、左上肺静脉口长径大于无血栓组,左心耳空间形态与无血栓组比较,差异有统计学意义(P<0.05);左心耳开口长径、开口短径、左心耳容积、开口周长、左心房容积、左上肺静脉口长径、菜花型、仙人掌型左心耳均与左心耳血栓形成具有相关性(OR=15.616、11.195、14.096、11.724、14.764、8.527、19.878、16.358,P<0.05)。结论CTA检查对左心耳血栓具有较高诊断价值,可客观、准确评估左心耳形态结构对血栓形成的影响,为临床术前评估血栓性事件风险提供依据。

Objective To investigate the relationship between quantitative evaluation of left auricular structure and thrombus formation by computed tomography angiography(CTA)in patients with non-valvular atrial fibrillation in Guangxi Zhuang population.Methods 180 patients with non-valvular atrial fibrillation in Guangxi Zhuang population from Chongzuo People's Hospital and Qinzhou First People's Hospital from July 2020 to June 2022 were selected,all of whom underwent transesophageal echocardiography(TEE)and cardiac CTA,and the value of CTA for diagnosing left heart ear thrombus was counted using TEE as the standard,and the agreement between CTA and TEE for evaluating the spatial morphology of the left heart ear was analyzed.According to whether there was thrombus in the left heart ear by TEE,we divided into thrombus group(80 cases)and non-thrombus group(100 cases),and compared the general data,short diameter of opening,long diameter of opening,circumference of opening,left ear volume,left atrial volume,long diameter of left superior pulmonary vein orifice,and left ear spatial morphology between the two groups,and analyzed the influencing factors related to left ear thrombus formation by using multi-factor logistic regression equation.Results A total of 77 cases of left auricular thrombus were detected by CTA,with a diagnostic sensitivity of 92.50%(74/80)and specificity of 97.00%(97/100);the agreement between CTA evaluation of left auricular spatial morphology and TEE was 98.89%(178/180),and the Kappa value was 0.983(95%CI:0.891-1.075)(P<0.05);the short diameter of the opening,long diameter of the opening,circumference of the opening,left ear volume,left atrial volume,and left upper pulmonary vein orifice length diameter were greater in the thrombus group than in the non-thrombus group,and the difference in the spatial pattern of the left ear was statistically significant when compared with the non-thrombus group(P<0.05);by logistic regression equation analysis,the short diameter of the opening,long diameter of the opening,circumference of the opening,left ear volume,left atrial volume,left upper pulmonary vein orifice length,left The left auricular opening short diameter,opening long diameter,opening circumference,left auricular volume,left atrial volume,left superior pulmonary vein orifice long diameter,cauliflower type,and cactus type left auricle were correlated with left auricular thrombosis(OR=15.616,11.195,14.096,11.724,14.764,8.527,19.878,16.358,P<0.05).Conclusion CTA examination has a high diagnostic value for left auricular thrombosis and can objectively and accurately assess the influence of the morphological structure of the left auricle on thrombus formation,providing a basis for preoperative clinical assessment of the risk of thrombotic events.